Whoops by two

First whoops.

I have just started a woman on Alendronate for her osteoporosis. She presented with a vertebral crush fracture. Her bone density meant she was classified as having osteoporosis.

Well well well!! Look at what I found in OverdosedAmerica. A study on this drug in 1998 done to see whether this drug reduced hip fractures - the whole reason for giving it - showed an increase in hip fracture of 84%. Due to the small numbers of hip fractures this wasn't statistically significant. There was also a 50% increase in wrist fractures which may be statistically significant.

Yes this drug increases the bone density but maybe not in a way that increases bone strength. Much drug promo is based on DOE, disease orientated evidence, rather than POE, patient orientated evidence. This is a great example. We need to look for the POE or POEM - this is patient orientated evidence that matters.

I have been a little unfair here because thus study was done on women with osteopenia rather than osteoporosis. However in reality there are no such things as osteopenia and osteoporosis. These are arbitrarily attached labels. There will no doubt be a distribution of bone density at various ages - where what is abnormal is a matter of opinion.

Anyway to give the best picture for these type of drugs. In women between 70 and 79 with a history of a vertebral fracture (often silent and picked up coincidentally on X-ray) 100 hundred women have to take the medication for one year to prevent one hip fracture. BUT there was no difference in serious illness rate (death or hospitilisation) between placebo and active pill takers. There are also some side effects - like perforation of the oesophagus. Very rare but very significant.

2 out of three hip fractures occur in those over 80. In a study of close to 4,000 folk over 80 - 80% had osteporosis - showed no effect on the incident of hip fracture.

There's a lot of pill swallowing going on out there that, for the vast majority of us, does diddly squat except for side effects of course.

In a study of nursing home residents averaging over 80 years of age people were randomised into two groups. One group received usual car. The treatment group went through an exercise programme, a medication review, they wore hip protectors and any fall was conferenced to see if any preventive measures could be taken. 1.6 percent of latter group had a hip fracture. 6.1% of control group had hip fractures!!


Second whoops
A mum requested some Phenergan for her wee infant with an itchy rash. I have been giving this for years on an occasional basis. A few years back the FDA put out a warning that there have been some infant deaths maybe due to Phenergan. Do not give to under two year olds!! I came across this yesterday at this really great site on drugs. It costs 15 US dollars a year. It is packed with information.