Questioning the Accuracy of a Recent Review of Osteoporosis Medications
Authors: Laura N. Kuhl
Journal: Annals of Internal Medicine (2009)

Letters17 March 2009Questioning the Accuracy of a Recent Review of Osteoporosis MedicationsLaura N. Kuhl, BA, Bruce Ettinger, MD, Clifford J. Rosen, MD, and Nananda F. Col, MD, MPP, MPHLaura N. Kuhl, BAFrom Maine Medical Center, Scarborough, ME 04074; University of California, San Francisco, San Francisco, CA 94110; and Maine Medical Center, Portland, ME 04101.Search for more papers by this author, Bruce Ettinger, MDFrom Maine Medical Center, Scarborough, ME 04074; University of California, San Francisco, San Francisco, CA 94110; and Maine Medical Center, Portland, ME 04101.Search for more papers by this author, Clifford J. Rosen, MDFrom Maine Medical Center, Scarborough, ME 04074; University of California, San Francisco, San Francisco, CA 94110; and Maine Medical Center, Portland, ME 04101.Search for more papers by this author, and Nananda F. Col, MD, MPP, MPHFrom Maine Medical Center, Scarborough, ME 04074; University of California, San Francisco, San Francisco, CA 94110; and Maine Medical Center, Portland, ME 04101.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-150-6-200903170-00015 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Because the choice of osteoporosis drugs often depends on their nonskeletal effects, it is important that clinicians have access to accurate information about their benefits and risks. In this regard, the article by MacLean and colleagues (1) fails in several respects.MacLean and colleagues report that ibandronate protects against upper gastrointestinal perforations, ulcers, and bleeding (odds ratio, 0.33 [95% CI, 0.14 to 0.74]). This finding is based on 2 studies (2, 3), neither of which reports a difference between ibandronate and placebo.In addition, the authors did not include important benefits and risks of some drugs. Raloxifene ...References1. MacLean C, Newberry S, Maglione M, McMahon M, Ranganath V, Suttorp M, et al. Systematic review: comparative effectiveness of treatments to prevent fractures in men and women with low bone density or osteoporosis. Ann Intern Med. 2008;148:197-213. [PMID: 18087050] LinkGoogle Scholar2. Chesnut CH, Skag A, Christiansen C, Recker R, Stakkestad JA, Hoiseth A, et al; Oral Ibandronate Osteoporosis Vertebral Fracture Trial in North America and Europe (BONE). Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res. 2004;19:1241-9. [PMID: 15231010] CrossrefMedlineGoogle Scholar3. McClung MR, Wasnich RD, Recker R, Cauley JA, Chesnut CH, Ensrud KE, et al; Oral Ibandronate Study Group. Oral daily ibandronate prevents bone loss in early postmenopausal women without osteoporosis. J Bone Miner Res. 2004;19:11-8. [PMID: 14753731] CrossrefMedlineGoogle Scholar4. MacLean C, Alexander A, Carter J, Chen S, Desai SB, Grossman J, et al. Comparative effectiveness of treatments to prevent fractures in men and women with low bone density or osteoporosis. Comparative Effectiveness Review No. 12. (Prepared by the Southern California/RAND Evidence-based Practice Center under contract 290-02-0003). Rockville, MD: Agency for Healthcare Research and Quality; 2007. Accessed at effectivehealthcare.ahrq.gov/healthInfo.cfm?infotype=rr&ProcessID=8&DocID=73 on 13 January 2009. Google Scholar5. Grady D, Ettinger B, Moscarelli E, Plouffe L, Sarkar S, Ciaccia A, et al; Multiple Outcomes of Raloxifene Evaluation Investigators. Safety and adverse effects associated with raloxifene: multiple outcomes of raloxifene evaluation. Obstet Gynecol. 2004;104:837-44. [PMID: 15458908] CrossrefMedlineGoogle Scholar6. Johnston CC, Bjarnason NH, Cohen FJ, Shah A, Lindsay R, Mitlak BH, et al. Long-term effects of raloxifene on bone mineral density, bone turnover, and serum lipid levels in early postmenopausal women: three-year data from 2 double-blind, randomized, placebo-controlled trials. Arch Intern Med. 2000;160:3444-50. [PMID: 11112238] CrossrefMedlineGoogle Scholar7. Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA. 1999;282:637-45. [PMID: 10517716] CrossrefMedlineGoogle Scholar8. Barrett-Connor E, Mosca L, Collins P, Geiger MJ, Grady D, Kornitzer M, et al; Raloxifene Use for The Heart (RUTH) Trial Investigators. Effects of raloxifene on cardiovascular events and breast cancer in postmenopausal women. N Engl J Med. 2006;355:125-37. [PMID: 16837676] CrossrefMedlineGoogle Scholar9. Vogel VG, Costantino JP, Wickerham DL, Cronin WM, Cecchini RS, Atkins JN, et al; National Surgical Adjuvant Breast and Bowel Project (NSABP). Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA. 2006;295:2727-41. [PMID: 16754727] CrossrefMedlineGoogle Scholar10. Fisher B, Costantino JP, Wickerham DL, Redmond CK, Kavanah M, Cronin WM, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998;90:1371-88. [PMID: 9747868] CrossrefMedlineGoogle Scholar11. Reid DM, Hughes RA, Laan RF, Sacco-Gibson , Wenderoth DH, Adami S, et al. Efficacy and safety of daily risedronate in the treatment of corticosteroid-induced osteoporosis in men and women: a randomized trial. European Corticosteroid-Induced Osteoporosis Treatment Study. J Bone Miner Res. 2000;15:1006-13. [PMID: 10841169] CrossrefMedlineGoogle Scholar12. Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001;344:1434-41. [PMID: 11346808] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Laura N. Kuhl, BA; Bruce Ettinger, MD; Clifford J. Rosen, MD; Nananda F. Col, MD, MPP, MPHAffiliations: From Maine Medical Center, Scarborough, ME 04074; University of California, San Francisco, San Francisco, CA 94110; and Maine Medical Center, Portland, ME 04101.Disclosures:Honoraria and consultancies: B. Ettinger (Berlex, Duramed-Barr, Eli Lilly, GlaxoSmithKline, Novartis, Proctor & Gamble, Roche, Schering-Plough), C.J. Rosen (Takeda Pharmaceuticals). PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSystematic Review: Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis Catherine MacLean , Sydne Newberry , Margaret Maglione , Maureen McMahon , Veena Ranganath , Marika Suttorp , Walter Mojica , Martha Timmer , Alicia Alexander , Melissa McNamara , Sheetal B. Desai , Annie Zhou , Susan Chen , Jason Carter , Carlo Tringale , Di Valentine , Breanne Johnsen , and Jennifer Grossman Questioning the Accuracy of a Recent Review of Osteoporosis Medications Catherine MacLean and Marika Suttorp Metrics 17 March 2009Volume 150, Issue 6Page: 423-424KeywordsBreast cancerDrugsHemorrhageLongitudinal studiesOdds ratioOsteoporosisRelative riskRisk managementScientistsUlcers ePublished: 17 March 2009 Issue Published: 17 March 2009 Copyright & PermissionsCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...