Routine monitoring not needed with bone drugs

Routine testing of bone thickness is not needed and may be misleading in postmenopausal women who have been taking Fosamax (alendronate) and related bone-building drugs for 3 years, according to a report in the British Medical Journal.

Many doctors measure bone thickness or density to estimate a patient’s response to drug treatments for osteoporosis, but there is no evidence that this is beneficial, Dr. Katy J. L. Bell, from the University of Sydney, Australia, and colleagues write.

To assess the value of this approach, the researchers analyzed data from the Fracture Intervention Trial, a study comparing Fosamax with placebo in 6459 postmenopausal women with low bone density. Standard tests were used to measure bone density at the hips and spine when the study began and at 1, 2 and 3 years.

Treatment with Fosamax for 3 years significantly increased hip bone density, the report indicates. The results showed that regular monitoring of bone density was unnecessary since there was very little variation between patients in the response to Fosamax.

In a related editorial, Dr. Juliet Compston, from the University of Cambridge School of Clinical Medicine, UK, emphasizes that “routine monitoring of bone mineral density during the first few years of (drug therapy) cannot be justified because it may mislead patients, lead to inappropriate management decisions, and waste scarce healthcare resources.”

SOURCE: British Medical Journal, June 25th Online First issue, 2009.