In the Journals

Bisphosphonate use drops after media reports of safety concerns

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June 18, 2015

Media reports calling into question the safety of bisphosphonates to treat osteoporosis led to a sharp drop in use of the drug between 2008 and 2012, according to a study in the Journal of Bone and Mineral Research.

In an analysis of relevant media reports and Internet search trends concerning bisphosphonate use and hip fracture, along with data from national prescription drug and health care databases, researchers found that, after a decade of increasing growth, bisphosphonate use declined by 50% between 2008 and 2012 as media reports highlighted the potential for certain fractures in long-term users of bisphosphonates, such as Fosamax (alendronate sodium, Merck).

“Our study documents a dramatic drop in osteoporosis medication use by patients,” Timothy Bhattacharyya, MD, head of the clinical and investigative orthopedics surgery unit at the National Institute of Arthritis and Musculoskeletal and Skin Diseases, said in a press release. “Whether it will impact the long-term bone health of the nation remains to be seen.”

Bhattacharyya, Smitha Jha, MD, of the NIH, and colleagues analyzed data from the Medical Expenditure Panel Survey (MEPS), an annual survey of U.S. families and individuals, their medical providers and their employers, to calculate the proportion of patients with at least one bisphosphonate prescription in annual surveys from 1996 to 2012 among responders aged at least 55 years. Researchers also analyzed data from the National Inpatient Sample (NIS) to estimate national hospital stays for hip fracture (excluding open hip fractures) nationwide. Researchers also analyzed Google Trends data between 2004 (the earliest records were available) and 2015 to study the frequency of Internet searches for both the brand and generic names of bisphosphonates.

Researchers found “Fosamax” to be the most consistently searched term among generic and brand name bisphosphonates between 2004 and 2015, and found news articles regarding Fosamax and bisphosphonates correlating to the dates of major spikes in search frequency.

“The first prominent spike was noted in 2006, when the first lawsuit was filed against Merck and Co. Inc. for osteonecrosis of the jaw,” the researchers wrote. “The second spike was seen in 2008, after a study published in the Archives of Internal Medicine showed an increased risk of atrial fibrillation with use of alendronate.”

An ABC World News program linking alendronate to atypical femur fractures in 2010 also led to an increase in the use of “Fosamax” as an Internet search term, according to researchers.

Researchers also found a decline in bisphosphonate use primarily among white women, from 86.4% in 2008 to 78.1% in 2012 (P < .009). Less educated women also showed a significant decrease in bisphosphonate use, dropping from 15.3% in 2008 to 11.8% in 2012 (P <  .01) vs. college-educated women, as well as a significant decrease in the rural population, from 17.2% in 2005 to 12.6% in 2008 (P <  .03), compared with the urban population.

“This finding highlights an important change in patient behavior as being ‘active’ consumers of the drug market,” the researchers wrote.

Despite the decrease in bisphosphonate use, the hospitalization rate for intertrochanteric hip fracture declined from 478.9 per 100,000 in 1996 to 355.3 per 100,000 in 2006; decreasing even further to 305.8 per 100,000 in 2012.

A decline in intertrochanteric fracture that accompanies the drop in bisphosphonate use is likely due to other factors, according to researchers, who cautioned that patients must be educated on the benefits of the drug.

“As members of the scientific community, clearly we need to do better in disseminating and translating our message to the community at large,” the researchers wrote. “Continued decrease in the incidence of intertrochanteric fracture has been seen in spite of decreasing use of oral bisphosphonates, possibly due to long residence of bisphosphonates in bones, better targeting of therapy and trends in vitamin D repletion, physical activity, etc.” – by Regina Schaffer

Disclosure: The researchers report no relevant financial disclosures.

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