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Osteoporosis drug monitoring 'unnecessary'

Wednesday June 24th, 2009

Monitoring women on anti-osteoporosis treatment is a waste of resources, experts say today.

A team led by Professor Les Irwig of the University of Sydney, Australia, assessed the value of monitoring responses to bisphosphonate drugs for preventing osteoporosis. The team had doubts over the value of such monitoring.

They evaluated a trial of 6,459 postmenopausal women with low bone mineral density, given either the bisphosphonate drug alendronate or a placebo. The women's hip and spine bones were evaluated after one, two, and three years on treatment.

On the website of the British Medical Journal, the researchers report that after three years, the drug increased hip bone mineral density by an average of 0.030g per square cm. The variation in response was small, they report. On placebo, hip bone density decreased by an average of 0.012g per square cm.

"Alendronate treatment is estimated to result in increases in hip bone density of greater than or equal to 0.019g per square cm in 97.5 per cent of patients," they write.

"Increases in bone density of at least this size are likely to be considered sufficient to continue therapy in most clinical populations", so monitoring is "unnecessary and best avoided".

In an editorial, Professor Juliet Compston of Cambridge University, UK, agrees that monitoring is "potentially misleading and a misuse of healthcare resources".

She writes that patients and doctors seek reassurance that the treatment is working, but routine monitoring is costly and "may divert healthcare resources away from more deserving causes".

The new findings "strengthen the case against routine monitoring of bone mineral density during the first few years of treatment", she concludes.

Bell, K. J. L. et al. Value of routine monitoring of bone mineral density after starting bisphosphonate treatment: secondary analysis of trial data. The British Medical Journal, 2009;338:b2266.

Compston, J. Monitoring bone mineral density during antiresorptive treatment for osteoporosis, The British Medical Journal, 2009;338:b1276.

Tags: Australia | Geriatric Health | Orthopaedics | Pharmaceuticals | UK News | Women’s Health & Gynaecology

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