Mind Your Bones

Bisphosphonates may not effectively prevent hip fracture

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Older adults are commonly prescribed drugs to strengthen their bones and combat injury. But these may be unnecessary when it comes to preventing one dangerous ailment.

Although past research has found that bisphosphonates may help strengthen bones, one new study found a lack of evidence to support the use of these bone-strengthening drugs to prevent hip fractures.

"The dominant approach to hip fracture prevention is neither [practical] as a public health strategy nor cost effective," wrote lead study author Teppo Jarvinen, MD, a professor at the University of Helsinki and researcher at the Helsinki University Central Hospital Department of Orthopaedics in Finland, and colleagues.

Dr. Jarvinen and team looked at the practice of prescribing medication to prevent hip fractures in at-risk older adults. Older adults at risk for hip fractures are commonly prescribed medication to strengthen bone density. They found that standard assessments for hip fracture risk may overestimate the number of candidates for osteoporosis treatment.

Osteoporosis is a condition that causes the bones to become weak or brittle.

"The optimum rationale for the prevention of serious consequences of bone fragility is to adequately screen for [osteoporosis] and history of falls, implement [methods] such as fall prevention, exercise, nutrition, and make a collaborative decision with the [doctor] and the patient together about whether [medication] makes sense or not," said Alan L. Jones, MD, medical director of orthopedic trauma at Baylor University Medical Center at Dallas and professor at Texas A&M University, in an interview with dailyRx News.

Dr. Jarvinen and team looked at more than 30 trials involving bisphosphonates prescribed to treat fragile bones. They found that bisphosphonates only appeared to lower the risk of hip fractures in women by less than 1 percent over a three-year period.

Bisphosphonates are the dominant class of drugs prescribed for osteoporosis and hip fracture prevention. Bisphosphonate brand names may include Fosamax, Boniva, Actonel, Atelvia and Reclast.

Dr. Jarvinen and team also found no evidence that bisphosphonates helped to prevent hip fractures or that it was a cost-effective option.

According to the Mayo Clinic, falls are more likely to cause hip fractures than weak bones. Less than 1 in 3 hip fractures are caused by osteoporosis. Among those over age 65, 33 percent also fall at least once a year. This number increases to 50 percent by age 80.

Being active and eating well may be more effective in preventing hip fractures than medication to strengthen bones, according to Dr. Jarvinen and team.

Dr. Jarvinen and team found that physical activity reduced the risk of hip fractures by 60 percent.

"[Medication] can achieve at best a [minimal] reduction in hip fractures at the cost of unnecessary psychological harms, serious medical adverse events, and foregone opportunities to have greater impacts on the health of older people," Dr. Jarvinen and team wrote.

This study was published May 26 in the journal The BMJ.

The Academy of Finland and the Sigrid Juselius Foundation funded this research. One study author provided expert testimony in a class-action lawsuit.

Review Date: 
May 26, 2015
Last Updated:
May 28, 2015