Trends in Media Reports, Oral Bisphosphonate Prescriptions, and Hip Fractures 1996–2012: An Ecological Analysis

Abstract

Bisphosphonates are effective for the treatment of osteoporosis despite recent reports of safety concerns such as atypical femur fracture. We conducted an ecological analysis of relevant media reports, oral bisphosphonate use, and fracture outcomes in the United States. Trends in media reports and public interest of bisphosphonates were quantified using data from Google Trends. Data from the Medical Expenditure Panel Survey (MEPS) and the National Inpatient Sample (NIS) were used to estimate the trends in oral bisphosphonate use among patients aged 55 years and older and hospitalizations for intertrochanteric and subtrochanteric fractures, respectively. These trends in the prevalence of oral bisphosphonate use and the age-adjusted incidence rate of intertrochanteric and subtrochanteric fractures were examined from 1996 to 2012. A series of spikes in Internet search activity for alendronate (Fosamax) occurred between 2006 and 2010 immediately following media reports of safety concerns. Oral bisphosphonate use declined by greater than 50% between 2008 and 2012 (p < 0.001) after increasing use for more than a decade.

Atypical fracture with long-term bisphosphonate therapy is associated with altered cortical composition and reduced fracture resistance

“…1). Patient anxieties about side effects have contributed to a crisis in osteoporosis treatment arising from a 50% decrease in use of oral bisphosphonates between 2008 and 2012, raising the specter of a return to high rates of hip fracture previously thought to have been reduced following the widespread prescription of bisphosphonates for postmenopausal osteoporosis (8)(9)(10).…”

Bone mineral density screening and its accordance with Canadian clinical practice guidelines from 2000–2013: an unchanging landscape in Saskatchewan, Canada

“…However, notably, our study showed a significant decline in osteoporosis drug therapy, particularly in the last two time strata. This may correspond to popular media reports of safety concerns of bisphosphonates [24]. Further research is needed to determine this relationship and whether a post-fracture care gap exists, as it is well-established that patients who experience fracture and are thus at risk for future fracture are infrequently screened and prescribed drug therapy [5,[9][10][11].…”

A General Agent-Based Model of Social Learning

“…A recently published example of this situation comes from the use of bisphosphonates to treat osteoporosis. Although the benefits of these drugs outweigh the potential costs, their use trades off a reliable benefit through reduced hip and spine fractures against a very rare side effect causing deterioration of the lower jaw (Kennel and Drake, 2009;Crandall, Newberry et al, 2014;Jha, Wang et al, 2015). Our ABM demonstrates that at short time scales the first outcome will dominate, while at longer time scales the rare, negative outcome will affect decision making.…”