Elderly women on bone drugs may live longer

NEW YORK (Reuters Health) - While bone drugs have gotten a bad rap in the media recently, experts hope mounting evidence of benefits may convince patients not to shun the medicines.

This month, Australian researchers published the latest report to hint that elderly women who take bisphosphonates - as the bone drugs are known -- live longer than those who don't get treatment.

Out of every hundred women in their study, three who were not taking bone drugs died every year, compared to less than one of those who were on the drugs.

Although the findings don't prove the bone drugs actually boost longevity -- it's possible that women on treatment are generally healthier, for instance -- they fit with earlier studies.

"To me, this was good news," said Dr. Ethel S. Siris, who heads the Toni Stabile Osteoporosis Center at Columbia University in New York and was not involved in the study.

Examples of bone drugs are Merck's Fosamax, Roche's Boniva, Novartis's Reclast, and Warner Chilcott's Actonel.

They are usually prescribed for the bone-thinning disease osteoporosis, which affects about 10 million Americans, the majority of them postmenopausal women.

The disease makes the bones brittle and raises the chance of fractures, which have been linked to earlier death.

Estimates from Siris' team published in January show the drugs may have staved off more than 144,000 fractures among post-menopausal American women over an eight-year period.

Last year, the U.S. Food and Drug Administration warned that the medications might raise the risk of an unusual type of thigh fracture, and there have also been a few cases of bone death, or osteonecrosis, of the jaw.

After Australian national television reported on that side effect in December 2007, prescription rates for bone drugs dropped sharply, leading to an estimated 130 extra fractures and 14 deaths over the following nine months, according to one study.

"The bad news is that overstating the levels of risk of side effects with these drugs -- which the media have been doing for some time now -- has led people to stop the drugs when they should be taking them," said Siris, who is also past president of the National Osteoporosis Foundation.

Experts hope the new survival findings may help reestablish confidence in the drugs, some of which can be bought for about $10 per month in the U.S.

Led by Dr. John A. Eisman of the Garvan Institute of Medical Research in Sydney, the researchers tapped into an ongoing study following elderly people in a small Australian city.

They grouped more than 2,000 people according to three kinds of drugs - bone drugs, hormone replacement therapy or calcium supplements with or without vitamin D.

Over about 15 years of follow-up time, 466 women and 400 men died. After accounting for several health factors, women who took the bone drugs were about two-thirds less likely to die during the study than those who weren't getting any treatment.

The reduction was 52 percent for men taking these drugs, but neither hormone treatment nor calcium was linked with a decrease in death rates.

"These findings have potentially extremely important consequences, which should have a major impact on the way osteoporosis treatment is viewed and used," the researchers, who report funding from drugmakers, write in the Journal of Clinical Endocrinology and Metabolism.

They add that many patients, even those with fractures, are not currently getting treatment, an "apathy (that) should no longer be tolerated," they say.

In an email to Reuters Health, Dr. Murray Favus, who directs the bone program at the University of Chicago Medical Center, said the new findings might ease concerns about the drugs.

Only about one in 100,000 people taking bone drugs actually develop osteonecrosis of the jaw, he said, and the atypical fractures linked to the drugs are also very uncommon he said.

"The concern about complications or just not being committed to the medication has led many patients to stop oral bisphosphonate therapy," he said.

"However, if one adds extended lifespan to the equation, will patients be willing to assume some risk for the long term complications in the pursuit of a longer life?"

Experts generally recommend screening for osteoporosis in anyone over 65, and as young as 50 if they have risk factors.

SOURCE: bit.ly/hxeOym The Journal of Clinical Endocrinology & Metabolism, online February 2, 2011.