Comparing medicines to prevent fractures in osteoporosis

According to a new report from the US Agency for Healthcare Research and Quality (AHRQ), bisphosphonates were no better than other osteoporosis medicines at treating osteoporosis or preventing fractures. Many medicines lower the risk of fractures in people with osteoporosis.

The comparison included the bisphosphonates alendronate (Fosamax), etidronate (Didronel), ibandronate (Boniva), pamidronate (Aredia), risedronate (Actonel) and zoledronic acid (Zometa), as well as oestrogen, calcitonin, calcium, vitamin D, testosterone, parathyroid hormone and selective oestrogen receptor modulators such as raloxifene and tamoxifen. The results:

Alendronate, etidronate, ibandronate, risedronate, calcitonin, teriparatide (a form of parathyroid hormone) and raloxifene reduce fractures in women with osteoporosis after the menopause.
Calcitonin, risedronate and teriparatide reduce fractures in men.
Alendronate, etidronate, ibandronate, risedronate, zoledronic acid, oestrogen, calcitonin, parathyroid hormone and raloxifene prevent spine fractures.
Alendronate, risedronate, zoledronic acid, oestrogen and parathyroid hormone prevent hip fractures and other non-spine fractures.
There wasn't enough evidence to compare exercise or testosterone with osteoporosis medicines.
Alendronate, risedronate or vitamin D may help people with Parkinson's disease or after a stroke, who are more likely to fall.
Side effects were generally mild. Oesophageal ulcers were reported with bisphosphonates, but rarely. Raloxifene increased the risk of blood clots in the lungs and of minor heart problems such as palpitations and chest pain, and raloxifene and oestrogen caused uterine bleeding. Rarely, sudden death of the jawbone (osteonecrosis) occurred in cancer patients given high-dose intravenous bisphosphonates.

Many patients stopped their medicines, because osteoporosis has no symptoms, because of side effects, or because frequent dosing (for example of calcium and vitamin D) was a nuisance, and not taking medicines as prescribed led to more fractures. Patients taking bisphosphonates weekly were more likely to keep taking them than those taking them daily.

Bisphosphonates are the most widely used osteoporosis medicines, but none was better than the others in effect or safety. Overall, these treatments work well to treat osteoporosis and prevent fractures, provided they are taken properly and continued.