Men's Osteoporosis Support GroupBisphosphonates and macular degeneration; fracture prevention book review J Ophthalmol. 2010;2010. pii: 206837. Epub 2010 Jul 25. Therapeutic effect of oral bisphosphonates on choroidal neovascularization in the human eye. Honda S and others. PMID: 20706646. This Japanese study used bisphosphonates to slow the vascularization (choroidal neovascularization) that occurs in the wet form of age-related macular degeneration (AMD) or pathological myopia (PM). There were 36 patients who took 5 mg oral alendronate for six months. There were multiple complex ophthalmic measurements taken before and after therapy, with improvements noted in all groups over 1, 3 or 6 months. The authors concluded, "Oral bisphosphonate should be further investigated as a possible therapeutic and preventive drug for CNV due to AMD and PM." Editor's comments. I don't normally cover non-osteoporosis issues, but this seems to be an important eye problem that might benefit from osteoporosis medications, the bisphosphonates, such as alendronate, risedronate, etc. Ideally one would like to have much larger clinical trials with various doses of the bisphosphonates tested to see which is the best therapy for AMD or PM, and to confirm the results in this small trial. But it might take many years for such studies to be done. In the mean time, especially in older individuals who might also have osteoporosis along with their AMD or PM, taking a bisphosphonate seems a safe short-term therapy. The individuals with eye problems could also be checked for osteoporosis which would require some approved medication anyway. If they have osteoporosis or osteopenia, that would be an additional need for the bisphosphonates. My main purpose for posting this is to give readers a heads up in case they, or someone they know, might benefit from this therapy because they have AMD or PM. If so, they should contact their ophthalmologist and inform him or her of this study to see if their eye problem might benefit from bisphosphonate therapy. Also note the authors used the word "preventive" in their conclusion. Especially if you feel your family history might make you susceptible to AMD or PM, you might want to discuss this study with your ophthalmologist to see if you are a candidate for preventive bisphosphonate therapy. This could be especially important since AMD can progress very rapidly, which would make treatment less effective, and prevention much more desirable. Comparative Effectiveness of Treatments To Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis [Internet]. MacLean C and others. PMID: 20704035. Free full text book is also available online, and can be downloaded as a PDF. This is a Comparative Effectiveness Review to compare the benefits in fracture reduction and the harms from adverse events (AE) among and within the various classes of treatment for low bone density. Editor's comments. This book has a huge amount of information regarding the effectiveness and the side effects from osteoporosis therapies. It is far too much to cover in an Update. But I want to make readers aware of it in case they wish to delve into all the details of the analysis. There are four key questions answered in the study results, with many additional details covered when answering each key question. Key Question 1. What are the comparative benefits in fracture reduction among and also within the following treatments for low bone density? Key Question 2. How does fracture reduction resulting from treatments vary between individuals with different risks for fracture as determined by bone mineral density (borderline/low/severe), prior fractures (prevention vs. treatment), age, gender, glucocorticoid use, and other factors (e.g., community dwelling vs. institutionalized; vitamin D deficient vs. not)? Key Question 3. What are the adherence to and persistence with medications for the treatment and prevention of osteoporosis, the factors that affect adherence and persistence, and the effects of adherence and persistence on the risk of fractures? Key Question 4. What are the short- and long-term harms (adverse effects) of the therapies, and do these vary by any specific subpopulations?
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