Raymond Cole, DO Michigan State University, College of Osteopathic Medicine, East Lansing RECFCC@aol.com
Dr. Cole is a consultant to, and is on the speakers bureau of, F. Hoffmann-La Roche Ltd., GlaxoSmithKline, and Novartis Pharmaceuticals Corporation. He is also on the speakers bureau of Eli Lilly and Company and Medtronic. He received writing assistance for this article from BioScience Communications of New York, NY. Their assistance was supported by Novartis.
The Journal of Family Practice no longer accepts articles whose authors have received writing assistance from commercially sponsored third parties. This article was accepted prior to implementation of this policy
Possible downside to long-term use. Two studies presented at the 2010 annual meeting of the American Academy of Orthopaedic Surgeons showed that long-term use of oral bisphosphonates may diminish bone quality while increasing bone quantity, perhaps increasing the risk of atypical femoral fractures. In one study of 111 postmenopausal women—61 who received bisphosphonate therapy and 50 non-bisphosphonate controls—the bisphosphonate group exhibited improved structural integrity early in the course of treatment, but those gains were diminished at 4 years.35
In the other study, bone biopsy samples taken from the lateral femur in 21 postmenopausal women with femoral fractures (12 who received bisphosphonate therapy for an average of 8.5 years and 9 non-bisphosphonate controls) indicated that bisphosphonate therapy reduced the heterogeneity of bone tissue properties.36
FAST TRACK
To enhance compliance and persistence, consider an IV bisphosphonate for postmenopausal osteoporosis.
The Food and Drug Administration has said it is looking closely at all evidence, but that its review of data to date has not shown an unequivocal association between bisphosphonate use and increased risk of atypical femoral fractures.37
A new approach to the management of osteoporosis To avoid noncompliance problems and the associated increase in fracture risk, consider IV bisphosphonates for first-line therapy in women with postmenopausal osteoporosis. The intermittent dosing regimens of IV bisphosphonates ensure 100% persistence throughout the dosing interval.
CORRESPONDENCE Raymond Cole, DO, Michigan State University College of Osteopathic Medicine, Osteoporosis Testing Center of Michigan, 107 Chicago Street, Brooklyn, MI 49230; RECFC@aol.com
