Scary Aspect of Osteoporosis Meds – Hip Atypical Subtrochanteric Fractures

Recent analysis had put hip fracture rates with bisphosphonate osteoporosis meds at 1/1000 per year. This is way too common – I have a suggested treatment.

Osteoporos Int. 2010 Nov 18. [Epub ahead of print]
Subtrochanteric fractures after long-term treatment with bisphosphonates: a European Society on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, and International Osteoporosis Foundation Working Group Report.
Rizzoli R, Akesson K, Bouxsein M, Kanis JA, Napoli N, Papapoulos S, Reginster JY, Cooper C.
abstract here

  • “Common features of these ‘atypical’ fractures include prodromal pain, occurrence with minimal/no trauma, a thickened diaphyseal cortex and transverse fracture pattern.”
  • Suggested may occur in 1/1000 cases.

With osteoporosis, the number needed to treat to prevent one hip fracture is 107 with strict adherence – this is better than the 1/1000 (assuming one was treating an osteoporosis case – not just an osteopenia)

My answer to this – first of all, make sure calcium and vitamin D intake is adequate. Then determine is on an ulcer med – this will double osteoporosis rates unless only used every second day – something that may not happen without raising the head of bed (not just pillows, people).

If one truly has osteoporosis, it should be obvious that these drugs are not that great anyway. When patient can afford, combining a bisphosphonate (actonel, fosamax) – (can’t count didrocal because it doesn’t really cut hip fracture rates) with estrogens/progesterone if under 60 and female, or Evista in all females otherwise.  The combination has an additive effect:

Additive Effects of Raloxifene and Alendronate on Bone Density and Biochemical Markers of Bone Remodeling in Postmenopausal Women with Osteoporosis
The Journal of Clinical Endocrinology & Metabolism 87(3):985–992  free article here

I suspect the combo would prevent any abnormal bone deterioration.

Evista(raloxifene) has got considerable good press for breast cancer prevention (licenced for such now). |The Women’s Health Initiative, though a horrible study, did find breast cancer rates actually lower if on estrogens prior to age 60.

One article whined that there were a couple cases of endometrial hyperplasia on Evista – that is not cancer and I suspect could have happened anyway. Nonetheless, any postmenopausal bleeding needs workup…

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