No Osteoporosis Drug Proven Best
Over a Dozen Drugs Studied; None Emerges as Best Osteoporosis Treatment
By
Salynn Boyles
WebMD Health News
Reviewed By
Louise Chang, MD
Dec. 17, 2007 -- There is no proof that the most widely prescribed
osteoporosis drugs work better than other drug treatments for the
prevention of bone fractures.
That is the finding from a new report funded by the U.S. government's Agency
for Healthcare Research and Quality (AHRQ).
Based on an analysis of studies examining the risks and benefits of six
bisphosphonates and other osteoporosis drugs, researchers concluded that while
many medications reduced the risk of bone fractures in people with
osteoporosis, no single drug or drug class was clearly superior.
They noted that there was not enough data to determine if the
bisphosphonates were better for preventing fractures than hormone-based
treatments.
The popular osteoporosis drugs Fosamax and Boniva are bisphosphonates, which work by slowing the natural
process that breaks down bone tissue.
The researchers included in their analysis studies involving Fosamax,
Boniva, four other bisphosphonates (Didronel, Aredia, Actonel, and Zometa), the man-made hormone calcitonin, the selective
estrogen receptor modulators Evista and tamoxifen, parathyroid hormone,
estrogen, testosterone, calcium, and vitamin D.
"The fact is, there have been very few head-to-head trials done to
compare any of these agents," study author Catherine MacLean, MD, PhD, of
the RAND Corp., tells WebMD. "It is expensive to do these trials. On the
other hand, these are also expensive agents, and as consumers we have the right
to know which ones work best."
Many Patients Stop Treatment
The studies indicated that the effectiveness of calcium and vitamin D varied
according to the dosage taken, how often the supplements were taken, and whether osteoporosis
patients were at high risk for fractures.
Researchers also found compliance to be a problem with most osteoporosis
treatments and for calcium and vitamin D, which must be taken every day.
Patients were more likely to stay on longer-acting bisphosphonate treatments
than those that had to be taken daily.
At least one calcium study showed the supplement to benefit patients who
took it daily as directed, but not patients who took it less often than was
recommended, MacLean points out.
"As with any therapy, these treatments don't work unless you take
them," she says.
No single bisphosphonate was found to be superior to another for preventing
bone fractures.
The analysis was published online Monday and will appear in the Feb. 5
edition of the Annals of Internal Medicine.
More Study Needed
An official with the AHRQ says the report helps shed light on what is known
and not known about the effectiveness and safety of osteoporosis
treatments.
"Without question we need more studies examining the effectiveness of
different treatments," Jean Slutsky tells WebMD. "There is a lot of
uncertainty about how the supplements compare to the other therapies and how
the [prescription] drugs compared to each other."
This research is important, Slutsky says, because so many people elderly
people are at risk for osteoporosis and frequently life-altering fractures
related to bone weakening.
"About half of women over 50 will suffer an osteoporosis-related bone
break in their lifetime," she says. "We have all heard stories about
older people who were doing great until they fell and broke a hip and went into
a steady decline."
She adds that while it isn't clear which medications work best, it is clear
that most treatments do help reduce fracture risk when taken regularly.
"[Osteoporosis] is a largely treatable condition," she says.
Calls to Fosamax manufacturer Merck & Co. and Boniva manufacturer
Hoffmann-LaRoche were not returned by publication time.
SOURCES: MacLean, C., Annals of Internal Medicine, Feb. 5, 2008;
early release online version. Catherine MacLean, MD, PhD, RAND Corp., Santa
Monica, Calif. Jean Slutsky, PA, MSPH, director, Center for Outcomes and
Evidence, AHRQ.
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