Are Bisphosphonates Good or Bad for You Today? Part 2

As I noted this past Monday, the evidence for small but real risks associated w/bisphosphonate use continues to pile up.  But two reviews of bisphosphonate use in osteoporosis, one published this month in the Journal of Clinical Endocrinology & Metabolism, and the other published in May in the British Medical Journal, noted that the benefits of bisphosphonate outweigh the risks.  Because no medication, prescription or over-the-counter, or dietary supplement (whether herbal, natural, organic or otherwise) is without potential side effects, we always need to be as sure as we can that the potential for benefit outweighs the potential for harm.  If not, then we probably shouldn't prescribe the medication or take the supplement.

With that said, it's also important to take into account our patients' perspective.  For instance, when it comes to balancing the benefit of stroke prevention vs the risk of bleeding from use of warfarin, I personally would lean towards taking greater risk of bleeding so that I could prevent a devastating (to me) stroke, even though I could potentially die from a gastrointestinal hemorrhage.  But that's me wearing my patient hat.  Someone else might decide to avoid the risk of bleeding and take the risk of stroke.  Everyone's different.

Put it another way:  why gamble?  I don't, mainly because I view my chances of winning as far less than my chances of hitting it big, even though if I win, it's 100% for me.  Obviously, many other people analyze the same situation & risk differently.  Sin City wouldn't exist if all the tourists (and a healthy percentage of locals) weren't willing to wager their earnings on a chance at a bigger slice of pie.

When it comes to bisphosphonate use in osteoporosis, I believe that my risk for a typical osteoporotic fracture is dramatically greater than my risk for an atypical femur fracture.  All the studies point this out even as they also point out that bisphosphonates increase risk of atypical femur fractures.  So taking a bisphosphonate, even though it increases my risk for atypical femur fracture, dramatically lowers my greater risk of a typical osteoporotic fracture.  For me at least, the balance is in favor of taking bisphosphonates to prevent typical osteoporotic fractures.  

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