Pamela A. Popper, Ph.D., N.D.

Wellness Forum Health

According to a new study, sales of the most commonly prescribed drugs used to treat osteoporosis dropped by 50% between 2008 and 2012. The authors say that the reason is media reports detailing the side effects of the drugs have caused “…an important shift in patient behavior…”[1]  The news gets better. This study addressed only oral bisphosphonates, but other research shows similar declines in intravenous versions of these drugs too.[2]  In other words, consumers are playing a more active role in healthcare decisions, are seeking information on their own, and are increasingly willing to tell their doctors “no” when they disagree with recommendations. The researchers noted that the media cannot be held solely responsible for decreasing acceptance of osteoporosis drugs since bone experts have been advising that the length of time patients stay on the drugs should be limited even before the media started publicizing risks associated with taking them.

The authors also note that their study confirms the association between bisphosphonate drugs and increased risk of fracture of the femur bone. Fractures increased during the period of time when bisphosphonate use was increasing, and started decreasing when prescriptions started dropping.

The only disappointing part of the article was the suggestion that doctors and researchers need to do a better job of “…disseminating and translating our message to the community at large.” In medical–speak, this means doing a better job of selling drug treatment to patients.

Disease organizations agree that doctors should become better salesmen. The American Society for Bone and Mineral Research, the National Osteoporosis Foundation, and The National Bone Health Alliance have issued a statement encouraging doctors to become more aggressive in pushing bisphosphonate drugs to their patients.[3] But according to Dr. Paul D. Miller, medical director of the Colorado Center for Bone Research, more aggressive selling is not likely to work. He says, “Ninety percent of patients, when you talk to them about starting one of these drugs, won’t go on” and that 90% of those who take the drugs want to quit.[4]

In fact, half of the people who take the drugs quit within a year, and even those who have had a hip fracture are increasingly saying no” to a prescription.  In 2011, only 20% of patients who were hospitalized for a broken hip agreed to take the drugs when they left the hospital. Apparently it’s getting harder to scare even the people who have had fractures into taking bisphosphonates.

The refusal may be due to not only media attention to the risks of both femur fractures and osteonecrosis of the jaw, but also lawsuits that resulted in large awards, and changed FDA recommendations. The FDA issued a statement in 2010 requiring that the increased risk of atypical fractures be added to the Warnings and Precautions section of the label for bisphosphonates, and also that the Indications and Usage section state that it is unknown how long the drugs need to be taken in order to treat or prevent osteoporosis.[5] The FDA’s website also indicated other concerns about the drugs, which included kidney impairment, increased risk of esophageal cancer, and severe pain.[6]

At Wellness Forum Health, it is our mission to help patients to make more informed decisions about care. This is a marvelous development indicating that more patients are developing a healthy skepticism about healthcare recommendations, and one that I hope will continue to gain momentum.

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[1] Jga S, Wang Z, Laucis N, Bhattacharyya T. “Trends in Media Reports, Oral Bisphosphonate Prescriptions, and Hip Fractures 1996-2012: And Ecological Analysis.” J Bone Min Dens 2015 Dec;30(12):2179-2187

[2] Wysowski D, Greene P. “Trends in osteoporosis treatment with oral and intravenous bisphosphonates in the United States, 2002–2012.” Bone. 2013; 57(2):423–8

[3] Statement from American Society for Bone and Mineral Research, National Osteoporosis Foundation and National Bone Health Alliance:Nation’s Scientific and Medical Bone Health Experts Call for Action On Dangers of Not Treating Osteoporosis More Aggressively.”

[4] Gina Kolata “Fearing Drugs’ Rare Side Effects, Millions Take Their Chances With Osteoporosis.” New York Times June 1 2016

[5]  FDA Drug Safety Communication: Safety update for osteoporosis drugs, bisphosphonates, and atypical fractures. http://www.fda.gov/Drugs/DrugSafety/ucm229009.htm

[6] Bisphosphonates (marketed as Actonel, Actonel+Ca, Aredia, Boniva, Didronel, Fosamax, Fosamax+D, Reclast, Skelid, and Zometa) Information. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm101551.htm