Men's Osteoporosis Support GroupNOF osteoporosis Webinars; bisphosphonates and fracture reduction; long-term effects of percutaneous vertebroplasty The National Osteoporosis Foundation has Webinars available for free here. You can either sign up to view future Webinars live or you can view past webinars: "How Strong are Your Bones?" and "Nutrition for Bone Health." Note that there are also several PDF files there with additional information that you can download to read. J Bone Miner Res. 2010 Jul 26. [Epub ahead of print]. Estimating bisphosphonate use and fracture reduction among U.S. women age 45 and older, 2001-2008. Siris ES and others. PMID: 20126856. This study used large medical claims databases to find fracture incidence among 460,584 women 45 years or older taking bisphosphonates from 2001-2008. Fracture reduction was estimated based upon comparing those women in the group who took medications 50-79% and 80% of the time to those who took medications less that 50% of the time. The study found fracture reduction in the women taking the bisphosphonates more than 50% of the time and the authors suggest that 144,670 fractures were prevented. Editor's comments. A previous Update has discussed the problem of those with osteoporosis not adhering to or persisting with taking their osteoporosis medications. There appears to be a significantly reduced effect from bisphosphonates unless they are taken at least 80% of the time or more. The Siris and others study shows the cost in fractures, and obviously in pain, suffering and money, that could be prevented with better compliance when those with osteoporosis are prescribed bisphosphonates. I'm sure there are multiple reasons that people don't comply. This likely including the fact that low bone mineral density is often asymptomatic, side effects from the bisphosphonate are a rare occurrence, but they get heightened publicity making the individual afraid to take the medication, cost of medications might be a factor, and simple failure to take the medications as directed is likely also a big factor, especially in elderly people with memory problems. Osteoporos Int. 2010 Jul 27. [Epub ahead of print]. Long-term prospective study of osteoporotic patients treated with percutaneous vertebroplasty after fragility fractures. Mazzantini M and others. PMID: 20661546. This study involved 115 patients who had undergone percutaneous vertebroplasty (PVP) and who were then given oral bisphosphonates, calcium and vitamin D supplements and followed up for 39 months. The study found that 32 patients (27.8%) had repeat vertebral fractures. Compared to those who didn't re-fracture, these individuals had significantly low BMI (body mass index), total hip and femoral neck T-scores, and lower levels of serum vitamin D, Editor's comments. This study is interesting because it gives objective information regarding what to look for to prevent another fracture after having PVP. Low BMI is easily noted because these individuals are quite thin, and dual-energy X-ray absorptiometry (DXA) can easily determine whether hip and femoral neck T-scores have improved. Serum vitamin D levels can be checked via routine lab tests. Interestingly, there is no mention of how well the patients complied with taking their bisphosphonates and/or vitamin D supplements. As shown by the Siris and other study above, this is quite important and should be verified and reinforced, especially to these individuals who have fractured previously and undergone surgical procedures due to the fracture. In those who have had PVP, routine retesting of serum vitamin D levels to verify the supplements have returned them to normal levels would appear to be needed. See this Osteoporosis Issues page for more on vitamin D. So if you have had PVP or kyphoplasty, be sure you take your FDA-approved osteoporosis medication according to directions and that your care provider follows up to verify your BMD is improving and that your serum vitamin D levels have returned to normal levels. You don't want an additional fracture and PVP if it can easily be prevented.
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