english.prescrire.org > Spotlight > 100 most recent > Osteoporosis and the prevention of fractures: bisphosphonates offer little benefit after 5 years

Spotlight

Every month, the subjects in Prescrire’s Spotlight.

100 most recent :  1 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90

Osteoporosis and the prevention of fractures: bisphosphonates offer little benefit after 5 years

Bisphosphonate treatment for postmenopausal women with severe osteoporosis provides limited efficacy for the first 5 years, but can cause sometimes severe adverse effects. Beyond this period, the benefit is minimal given the adverse effects.

Osteoporosis (decline in bone mineral density) is frequent in postmenopausal women. It can be severe and lead to fractures, particularly of the spine and the hip. In postmenopausal women with severe osteoporosis, alendronic acid is the first-line drug for preventing fractures. It prevents 1 hip fracture and 3 vertebral fractures per 100 patients treated over 3 years. This limited efficacy should be weighed up against the adverse effects, especially œsophageal lesions, ocular disorders, osteonecrosis (irreversible bone destruction) of the jaw, etc. It is worth considering the results of a study carried out on more than 1,000 women being given alendronic acid after an initial 5-year treatment. After a further 5 years, the extended treatment prevented only 1 symptomatic vertebral fracture for 100 patients treated, and no hip fractures.

Before extending alendronic acid treatment for the prevention of bone fractures in postmenopausal women with severe osteoporosis, the minimal expected benefit should be weighed up against the proven risk of potentially serious adverse effects.

©Prescrire May 2008

Source: "Prévention des fractures : pas de diphosphonates indéfiniment" Rev Prescrire 2008; 28 (295) 373.

- More articles in Prescrire's "Spotlight"...