Wednesday, 18 Sep 2019

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Patient Reluctance to Take Bisphosphonates

The NY Times reports that millions of Americans with osteoporosis are driven to stop or not take bisphosphonate therapies over the fear of exceedingly rare side effects - osteonecrosis of the jaw (ONJ) and atypical femoral fractures (AFF).

Patient and physician reaction to these rare reports have resulted in a 50 percent decrease in these drugs from 2008 to 2012, and the trend continues.

Osteoporosis leaders have voiced their concern over the inappropriate reactions to ONJ and AFF, such that the American Society for Bone and Mineral Research, the National Osteoporosis Foundation and the National Bone Health Alliance have all put out an urgent call for doctors to be more aggressive in treating patients at high risk for fracture and calling for better education of patients.  Nonetheless, many physicians note that many patients won't go on these agents and many of those who are on bisphonsphonates wish to stop.

Dr. Paul Miller has recently written that "the benefit/risk ratio of bisphosphonates reducing all fracture risk vs the potential for the development of an atypical sub-trochanteric femur fracture is exceedingly in favor of bisphosphonate use in higher risk populations." (Citation source

The estimated risk of AFF with bisphosphonates is 10 to 40 events per 100,000 users. Fewer than one in 100,000 have had the ONJ.

Drs. Black and Rosen have recently written in the NEJM ( that you need to treat 50 people to prevent a fracture, but you need to treat 40,000 to see an atypical fracture.

Clearly there is a dire need for better education of clinicians and patients on the benefits and risks of treating osteoporosis, especially those who are assessed to have a high risk of fracture.

The author has no conflicts of interest to disclose related to this subject

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