New Data Strengthens the Link Between Bisphosphonate Medications and Rare Femur Fractures: Calls Into Question Preventative Use

There is increasing concern at the FDA and among physician groups that evidence of a connection between bisphosphonate osteoporosis medications and an increased risk of atypical femur fractures.  This potential link calls into question what value states receive from funding long-term preventative prescription of these medications.

In light of recent data reported by a task force from the American Society of Bone and Mineral Research (ASBM), the FDA has released a new safety report on the link between bisphosphate osteoporosis medication and atypical femur fractures. These safety risks are being associated with long-term use of the drugs, which implicates not only the benefits of prophylactic use of these medications, but also the cost benefits of newer bisphosphate medications over cheaper generic alternatives. Women with pre-osteoporosis, osteopenia, are much less likely to suffer broken bones than women with full osteoporosis, but are often prescribed bisphosphate medications on the now-uncertain assumption that such treatment will halt or slow the progression into osteoporosis. While the healthcare costs of osteoporosis-related injuries are high, a detailed examination of the potential costs of the over-prescription of bisphosphonate medication must be considered in assessing the cost-effectiveness of prescription practices.

The uncertainty over osteoporosis prevention highlights the need for states to adopt academic detailing programs for publicly funded health programs to educate prescribers of bisphosphonates. Some physicians are waiting until a patient develops a higher risk of fracture prescription before using these medications than was common practice in the past. However, pharmaceutical industry representatives and detailers slow the adoption of evidence-based practices and put the industry's interests in selling newer, more expensive, medications to as many patients as possible ahead of effective patient treatment at optimum cost. At least three versions of alendronate, the generic form of the bisphosphonate drug Fosamax, have been available since 2008.The industry profits from the extensive prescription of brand-name bisphosphonates to currently healthy women, and states need to consider methods to disseminate the mounting data against such practices to prescribers. Rather than forcing physicians to sift through the data on their own while under countervailing pressure from pharmaceutical representatives, academic detailing programs provide best-practices guidelines based on scientific studies. Physicians can then tailor their prescribing practice to the most effective, cost-efficient treatments supported by data, rather than industry sales pitches. Washington D.C. has already instituted legislation that places strict guidelines on pharmaceutical industry detailing practices. This is a concern that affects all states however, and the costs of ignoring inefficient and risky prescription practices are already unacceptable.