White Coat Underground

From the medical journals

  • Common osteoporosis drugs do not increase the risk of unusual fractures (probably): Bisphosphonates (such as Fosamax and Actonel), a class of medications used to prevent fractures in osteoporosis, are effective in preventing certain types of common back and hip fractures.  As we’ve developed more patient-years of experience with the drugs, we’ve found certain problems, such as damage to the esophagus (which has been reduced by developing less frequent dosing regimens) and rare episodes of destruction of the jaw bone.  Data has now accumulated that we may be able to give these medications for a set period of time (probably five years) and get just as much benefit with less toxicity.  Overall, serious side effects are rare, and generic forms of these drugs are available, making them affordable as well.  But reports of another possible side effect have started to emerge in the literature.  There have been reports that while these drugs reduce common  fractures, they may increase less common fractures.   From the New England Journal of Medicine, we have a study suggesting that this is unlikely to be the case.  The primary problem with this study is that it is underpowered. These unusual fractures are so unusual that it’s difficult to draw any definite conclusions, but given the low risk of these fractures in both users and non-users of bisphosphonates, this appears to be a non-issue and shouldn’t affect the decision to prescribe or withhold these medications.
  • Novel serum markers may help predict cardiac mortality: In trying to predict patients’ risk of having heart attacks, we use certain lab tests such as LDL cholesterol and C-reactive protein.  A new study in Annals of Internal Medicine asks if there might be other tests to help improve our prognostic abilities.  This study looked at patients with established coronary heart disease and found that some of these markers helped predict mortality independent of more traditional tests already in use.