OSTEOPOROSIS TREATMENT DEBATE

Osteoporosis Treatment Debate

Today, over 10 million individuals have or are at risk of osteoporosis—80% are women. Almost 34 million more have low bone mass, placing them at increased risk for osteoporosis. With estrogen treatment running into controversy, there is now competition between two drugs to treat osteoporosis- Fosamax and Actonel.

Osteoporosis treatment is a hotly debated area in medicine. There’s been the concern over using estrogen, which protects bone but has side effects such as heart attack and cancer risk. Now, there’s this- the latest research focusing on two popular osteoporosis medicines has come up with a conclusion as to which is best, and the results are creating a bit of a controversy.

According to findings of the Fosamax-Actonel comparison trial, in fact the first U.S. head-to-head study comparing FDA approved once weekly osteoporosis treatments in postmenopausal women with osteoporosis, Fosamax provided greater increases in bone mineral density at all body sites, especially at the hip. In fact, Fosamax was as much as 84% more effective in increasing bone density than Actonel in certain locations.

Osteoporosis is a disease that causes bones to become more porous, gradually making them weaker and more brittle, and thus, more likely to fracture. Both Fosamax and Actonel are in the group of medications called bisphosphanates. They act to block bone reuptake, and thus, prevent thinning, and even cause an increase in bone density.

But the question is, which is more significant? Whether a drug can increase bone density or whether a drug can affect the true bottom line i.e. decreasing one’s risk of fracture? "When you get a bone density report it really only measures bone density. It doesn’t measure bone quality and more than likely bone quality is more important than bone density", says Dr. Paula Rackoff, Chief of Rheumatology at Beth Israel Medical Center in New York. She is like many experts who would say what one is really concerned about is the risk of fracture.

If any particular company wants the million dollar answer, they’ll have to do the head to head study on fracture risk. Until then, Dr. Rackoff believes that doctors should keep patients on the medicine they’re on right now. But hers is just one opinion in what is a very unclear situation. "I think the biggest message is that people need to pay attention to osteoporosis and there are two very good drugs that can reduce your fracture risk. If I really had to stretch and had someone with extremely low bone density I might give Fosamax over Actonel. But they both have very good fracture data", states Dr. Rackoff.

In individual studies on each drug, both showed about a 50% decrease in fracture risk, but again, the studies were independent of the other drug and did not look at them head to head. And overall, side effects are about the same with both Fosamax and Actonel, according to the research. For more information, click here: www.nof.org/