There has been some talk lately about whether it is really worthwhile to have as low a threshold as we do for treating osteoporosis with bisphosphonates, and some researchers have now put a useful figure on this – a meta-analysis shows that 175 women would have to take bisphosphonates for one year to prevent one hip fracture. (I’m not sure whether this was based on the thresholds we currently use for treatment.) There is little evidence available on men or on women over 80 yrs – the evidence we have available for the over-80s suggests no benefit of treatment. The authors point out that most hip fractures occur in patients without osteoporosis and that falling is a greater risk than osteoporosis (‘Do you have impaired balance?’ predicts around 40% of all hip fractures; the presence of osteoporosis predicts <30%.)
This was all very interesting – I’m looking forward to seeing what kind of feedback/alternative views they get in the letters. Meanwhile, it’s useful to have some figures to pass on when deciding on bisphosphonates. I wonder what the NNT is for the strategy of treating everyone who’s had a hip fracture/low-impact fracture, though?