Bone health

Osteoporosis drugs overpromoted, say critics of pharma industry

Claims that pharmaceutical industry-sponsored events are promoting osteoporosis overdiagnosis and influencing prescribing have been rejected by a leading endocrinologist.

An Australian study of 1,375 industry-sponsored events related to osteoporosis between 2011 and 2015 found sponsorship was highly concentrated into a few companies.

Amgen and GSK, which co-marketed denosumab at the time of the study*, together sponsored 49.4% of osteoporosis related events. Novartis sponsored 20% of events, Servier 15% and Sanofi 9%.

Denosumab dispensations increased nearly sevenfold during a similar period – up from 45,220 in 2012 to 309,350 in 2015.

Given that many of the 33,916 attendees were GPs, the authors postulated that promotion of products was likely to be to a broader population than would benefit from the osteoporosis drugs, the study authors said.

“The concentration of sponsorship by companies marketing products subject to safety, cost and efficacy concerns raises questions about influences on prescribing choice,” they wrote in BMJ Open.

“This pattern highlights the need for professional education to be free of commercial sponsorship,” they suggested.

However Professor Peter Ebeling, medical director of Osteoporosis Australia, rejected the idea that osteoporosis was overdiagnosed.

“In fact, Osteoporosis Australia believe the opposite – that less than 20% of people with fractures who come into the health care system are actually investigated or treated for osteoporosis.”

“It’s people with minimal trauma fractures that are really important because they are at the highest risk of getting future fractures. So this is one of the reasons we have been trying to target GPs.”

“Osteoporosis Australia feels very strongly that we need to work with GPs who manage osteoporosis as a condition in the community, and what we’re really focusing on is patients who have already had fractures.”

He said updated guidelines for the management of osteoporosis were published last year and endorsed by RACGP to help promote GP awareness of osteoporosis.

And there would be no risk of overtreatment with clinicians following the guidelines.

“We’ve been very careful to determine the treatment based on either the presence of a prior fracture or a high absolute fracture risk. Rest reassured that the guidelines in Australia focus on the treatment of high risk people for fractures and not bone density alone.”

Professor Ebeling acknowledged Osteoporosis Australia received funding from pharma including Amgen, as well as from the government.

“And that said, we couldn’t exist without that funding.”

He said there were a number of reasons for the popularity of denosumab.

“Australia is one of the few countries in the world where denosumab is registered as a first line drug for the treatment of osteoporosis and I think the advantage for GPs is the convenience. The patient only has to come every six months for a subcutaneous injection so in a way, GPs are responding to the fact that it is a convenient drug for patients and that they are involved in the administration of the drug.”

He added initial wariness about using a biologic had also largely gone.

“But when they developed familiarity with it, I think usage has increased whereas the other drugs have really decreased. There has also been some concern about adverse events associated with bisphosphonates such as atypical femur fractures and that may have reduced their use.”

“And certainly that has been the case in the US. Use of bisphosphonates after a hip fracture has declined by 50% over the last 10-15 years.”

*GSK and Amgen co-promoted denosumab prior to 2017 ,  currently in Australia Amgen promotes denosumab.

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