Think againBMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39546.558148.47 (Published 10 April 2008) Cite this as: BMJ 2008;336:0
All rapid responses
Dear Fiona Godlee,
I went through the recent study in great detail as also your connected
editorial (1, 2). Thank God, the former was free on line! The timing of
this study is vital to the points I am going to make below. As there were
a few good studies indicating the futility of bisphosphonates in the
treatment of this universal disease, osteoporosis, this new study appears
on the horizon!
Firstly, osteoporosis, as defined now, leads to virtual disease
mongering as the reference standard for bone density is the bone density
of teen age girls’ bones. Any one, screened above that age, must
proportionately be osteopaenic, if not osteoporotic, qualifying for
treatment. There are two preventive measures viz: regular exercise and
salt low diet for all ladies which would make genuine osteoporosis a
rarity. Calcium therapy might result in calcium induced calcium loss in
the distal tubule, resulting in negative calcium balance at the end of the
Coming to the science behind this study I wish to make three points.
a) It is retrospective and case record based; as such loses much of its
sheen, b) atrial fibrillation, for a long time, could remain paroxysmal,
and might not appear in the discharge diagnoses list and c) I could not
find if the controls were age and sex matched.
One of the important confounding factors is alcohol. Early
presentations of alcoholic cardiomyopathy could only be isolated
paroxysmal atrial fibrillation- a little beyond the stage of the so called
“T-P phenomenon” in the ECG where the T wave of the previous complex
almost merges with the P wave of the succeeding complex without an
isoelectric line in between complexes. I missed to see any particular
mention to alcohol intake in the two groups as also the ECG predictors of
AF. Another confounding factor could be coronary artery disease prevalence
in the two groups studied.
Lastly, almost all the authors seem to have had close connection with
the manufacturers of the drug in question. I don’t think that makes any
difference as we all take the Hippocratic Oath to follow the highest
ethical standards when we start our professional life, anyway? The caption
is from Leo Tolstoy.
1) Think again. Fiona Godlee BMJ 2008; 336:0
2) Oral bisphosphonates and atrial fibrillation. Sumit R Majumdar. BMJ 2008 336: 784-785.
Competing interests: No competing interests