An international team of researchers argues that the focus on drugs to prevent hip fractures is neither viable as a public health strategy nor cost effective.
Taking a hard fall is scary, especially the older we get.
In fact, a team of international researchers says falls, not osteoporosis, are to blame for most hip fractures in frail older adults.
Therefore, they conclude, drugs used to prevent hip fractures are not a viable treatment.
Dr. Teppo Järvinen, Ph.D., and colleagues at the University of Helsinki and Helsinki University General Hospital in Finland, say drug treatment “can achieve at best a marginal reduction in hip fractures at the cost of unnecessary harms and considerable waste of monetary resources.”
The researchers also state there isn’t sufficient evidence on the cost effectiveness of drug treatment. They add the focus on drug treatment means that alternative strategies, such as physical activity, are overlooked.
The researchers’ stance is outlined in an article that appeared this week in The BMJ as part of the publication’s Too Much Medicine campaign, which highlights the threat to human health and the waste of resources caused by unnecessary care.
About 1.6 million hip fractures occur across the world each year, according to the International Osteoporosis Foundation. This number could reach between 4.5 and 6.3 million by 2050.
Osteoporosis used to be diagnosed after a bone fracture. However in 1994, healthcare providers started identifying people who are at increased risk for fractures based on low bone mineral density.
The risk analysis is also used to calculate those who might benefit from bone building drugs.
Fracture risk calculators now classify 72 percent of white women in the United States over 65 years old and 93 percent of those over 75 years old as candidates for long-term drug treatment.
Researchers say this doesn’t make sense since the rates of hip fracture have fallen steadily in most Western countries, regardless of access to drugs.
They also point out that overdiagnosis and treatment causes harm, including the psychological burden associated with a disease label as well as adverse effects of drug treatment such as nausea, vomiting, and serious bone complications.
Researchers note that recent evidence also challenges the push for general use of calcium and vitamin D supplements to prevent fractures.
Järvinen and colleagues say there are alternatives to drug therapy to prevent hip fractures.
They say the non-drug approaches that have worked for 25 years include not smoking, being active, and eating well.
These approaches, they add, work for anyone, regardless of bone fragility.