New ‘Break’through: Research Provides New Insights Into Benefits of Osteoporosis Medications
SAN FRANCISCO – Drug treatments for osteoporosis have been shown to prevent bone loss and fractures in people with the illness. But few large-scale studies have been conducted to confirm whether these treatments can extend someone’s life.
New research led by investigators at Sutter’s San Francisco Coordinating Center (SFCC) suggests that drug treatments for osteoporosis should only be recommended for the prevention of fracture and not to prolong life expectancy. The findings were published online today in JAMA Internal Medicine.
“Some orthopedic specialists have concluded through observational studies that taking medicines that slow or prevent bone loss can directly reduce mortality. Some have also begun recommending that older people take those drugs, regardless of their risk of fractures,” says Steve Cummings, M.D., a senior scientist at California Pacific Medical Center, executive director of SFCC, and lead investigator for the study.
“But the research and opinions that these drugs reduce mortality are based on misleading studies. Taken together, the randomized trials in our analysis confirm that these drugs should be prescribed to patients at high risk of fracture for fracture reduction only.”
In collaboration with researchers at the University of California, San Francisco and the University of Sheffield, UK, Dr. Cummings examined 38 randomized, placebo-controlled clinical trials of drug treatments, particularly treatment with these medications (known as bisphosphonates). Clinical trials in the research included 101,642 unique patients with osteoporosis.
Databases including Science Direct, MEDLINE, Embase, and the Cochrane Library were searched for trials of drug treatments for osteoporosis. The analysis included data on mortality rates published after 2009, and published or in press before April 19, 2019. Conference abstracts from annual osteoporosis society meetings were also included in the search.
No significant association was found between all drug treatments for osteoporosis and overall mortality rate. Clinical trials of bisphosphonate treatment showed no significant association with overall mortality rate. In addition, clinical trials of zoledronic acid (also known as zoledronate, a medication used to treat a number of bone diseases) showed no association with overall mortality rate, although the results were inconsistent. Exploratory analyses also found no association with a decrease in mortality rates in clinical trials of other osteoporosis drugs like alendronate, bisphosphonate plus zoledronic acid, or nitrogen-containing bisphosphonate treatments, in clinical trials lasting at least three years.
In other words, Dr. Cummings cautions against believing the hype.
“Patients should be prescribed these treatments only in cases of high fracture risk,” says Dr. Cummings.