Bisphosphonates ‘likely to be beneficial’ for most older women with osteoporosis
medwireNews: Findings from a meta-analysis suggest that bisphosphonate therapy for osteoporosis is most likely to benefit postmenopausal women who have a life expectancy of more than 12 months.
William James Deardorff and colleagues, from the University of California, San Francisco in the USA, used data from 10 randomized controlled trials comprising a total of 23,384 postmenopausal women with osteoporosis to evaluate the time to benefit (TTB) of bisphosphonate therapy for the prevention of fractures. The average age of study participants ranged from 63 to 74 years, and the duration of follow-up was 12–48 months.
The team reports in JAMA Internal Medicine that the benefits of bisphosphonate treatment “increased in a nearly linear manner” with longer durations of follow-up. For instance, the number of nonvertebral fractures prevented per 100 women receiving bisphosphonates increased from 1.0 at 12 months to 1.5 at 18 months.
In all, 100 women would need to be treated with a bisphosphonate for 12.4 months to prevent one nonvertebral fracture at an absolute risk reduction (ARR) of 0.01.
“Because most postmenopausal women have a life expectancy that is substantially greater than 12.4 months, the results suggest that bisphosphonate therapy is likely to be beneficial for most older women with osteoporosis,” write Deardorff et al.
TTB analysis of secondary outcomes demonstrated that 200 women would need to be treated for 20.3 months to prevent one hip fracture (ARR=0.005), 7.7 months to prevent any clinical fracture (ARR=0.005), and 12.1 months to prevent one clinical vertebral fracture (ARR = 0.005).
“These results can be used to inform discussions between clinicians and older postmenopausal women who seek to balance the potential immediate harms and burdens of bisphosphonate therapy with the delayed benefit of decreased fracture risk,” write the study authors.
They explain that “[f]or some older women, the delayed benefits of bisphosphonates (decreased fracture risk) may be more important than the immediate risks (most commonly upper [gastrointestinal] symptoms),” whereas for others the risk for immediate adverse effects in exchange for potential longer-term benefits “may lead to a decision to forego bisphosphonate therapy.”
Deardorff and team stress that “[g]iven the uncertainty regarding harms and the substantial heterogeneity in life expectancy among older women, it is important to consider the values and preferences of individual older women when making decisions about bisphosphonate therapy.”
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