Intended for healthcare professionals

Views & Reviews From the Frontline

Bad medicine: osteoporosis

BMJ 2010; 340 doi: (Published 03 February 2010) Cite this as: BMJ 2010;340:c643

Unpleasant truth of osteoporosis medication

It was very refreshing to read Dr. Spence’s Frontline article (1). It
correctly highlights many points that make osteoporosis medication “bad
medicine”. In essence, osteoporosis itself is not really the issue, it is
fractures of older adults that matter. And when examining this issue more
deeply, one realises that falling, not osteoporosis, is the strongest
single risk factor for fractures. For this reason, we argued strongly in
our recent BMJ paper that the focus in fracture prevention should be
shifted from osteoporosis to falls (2).

Since osteoporosis is only a moderate level risk factor for
fractures, it is not surprising that the RCT-level evidence of drug
efficacy in fracture prevention is weak. And this is even before one
considers the relevant issues of drug effectiveness and cost-effectiveness
in real-life clinical setting. The evidence that taking medication can
prevent hip fractures is particularly limited, yet this is the most
expensive and devastating fracture among elderly people (3-5).

Simply put, osteoporosis medication has been promoted as being far
more effective than the research suggests; this is an unpleasant truth
that warrants increased public awareness.

Pekka Kannus, MD, PhD
Injury and Osteoporosis Research Center, UKK-Institute, Tampere, Finland

Teppo LN Järvinen, MD, PhD
Department of Surgery, University and University Hospital of Tampere,
Tampere, Finland

Karim M Khan, MD, PhD
Centre for Hip Health and Mobility, University of British Columbia,
Vancouver, British Columbia, Canada

1. Spence D. Bad medicine: osteoporosis. BMJ 2010;340:c1216.

2. Järvinen TL, Sievänen H, Khan KM, Heinonen A, Kannus P. Shifting
the focus in fracture prevention from osteoporosis to falls. BMJ. 2008 Jan

3. Inderjeeth CA, Foo ACH, Lai MMY, Glendenning P. Efficacy and
safety of pharmacological agents in managing osteoporosis in the old old:
review of the evidence. Bone 2009;44:744-751.

4. Feldstein AC, Weycker D, Nichols A, et al. Effectiveness of
bisphosphonate therapy in community setting. Bone 2009;44:153-159.

5. Rizzoli R, Bruyere O, Cannata-Andia JB, et al. Management of
osteoporosis in the elderly. Curr Med Res Opinion 2009;25:2373-2387.

Competing interests:
None declared

Competing interests: No competing interests

10 March 2010
Pekka A Kannus
Chief Physician
Teppo L.N. Järvinen, and Karim M. Khan
UKK Institute, FIN-33500 Tampere, Finland