Bone health

Fracture prevention an “intellectual fallacy” : experts


The current focus of using drugs to prevent hip fracture is achieving at best a marginal reduction in fractures at the cost of unnecessary harms and a considerable waste of resources, a group of international experts say.

Writing as part of the journal’s Too Much Medicine Campaign Professor Teppo Järvinen from the department of orthopaedics and traumatology at the University of Helsinki in Finland and colleagues say the current approach assumes that bone fragility — assessed by BMD and fracture risk calculators such as FRAX — predicts hip fracture and that subsequent drug treatment prevents fractures.

“Organisations supporting the development of FRAX, all heavily funded by drug companies, launched a campaign for widespread screening for bone fragility,” they wrote.

But overdiagnosis of bone fragility inevitably leads to overtreatment and as for most risk diseases, drug treatments eclipsed other forms of treatment such as lifestyle modification and physical activity, they noted.

Evidence showed drug treatments had marginal benefits, with a systematic review conducted by the team showing that 175 women must be treated with bisphosphonates for three years for each hip fracture prevented.

Moreover evidence on the cost effectiveness of drug treatment was lacking, with recent evidence also challenging the justification for the general use of calcium and vitamin D supplements to prevent fractures.

They also point to the harms from overdiagnosis and treatment, including the psychological burden associated with a disease label, and adverse effects of drug treatment such as nausea, vomiting, osteonecrosis of the jaw and drug-induced pathological fractures of the thigh bone. 

The dominant approach to hip fracture prevention “is neither viable as a public health strategy nor cost effective, conclude the authors.

“Pharmacotherapy can achieve at best a marginal reduction in hip fractures at the cost of unnecessary psychological harms, serious medical adverse events, and forgone opportunities to have greater impacts on the health of older people. As such, it is an intellectual fallacy we will live to regret,” they add.

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