Women’s Wariness of the Risks of Osteoporosis Drugs

http://www.nytimes.com/2016/06/16/opinion/womens-wariness-of-the-risks-of-osteoporosis-drugs.html

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To the Editor:

Re “Osteoporosis Drugs Shunned for Fear of Rare Side Effects” (front page, June 2): The National Osteoporosis Foundation appreciates your article regarding the risks versus benefits of medications for treatment of osteoporosis.

With 54 million Americans over the age of 50 affected by osteoporosis or low bone mass and at greater risk for fracture, it is vitally important that we help physicians and patients understand the need for appropriate testing and treatment. Osteoporosis causes about two million broken bones every year in the United States. If left untreated by medication, patients who break a bone are twice as likely to break another.

As your article notes, in recent years there has been a substantial reduction in the number of people receiving these proven osteoporosis therapies, even among those who have already fractured a bone and are at very high risk for another broken bone. We thank you for a balanced article that brings these concerns further to light and puts the rare risks of current therapies into a broader perspective.

KENNETH G. SAAG

President

National Osteoporosis Foundation

Birmingham, Ala.

To the Editor:

One reason for many women’s rejection of osteoporosis drugs is that some who remember doctors’ sometimes stern, well-meaning insistence that they should take hormone replacement therapy now feel glad they said no. Those who avoided blood clots and other side effects associated with early oral contraceptives, enthusiastically recommended at the time, look back and feel similarly.

Women have become understandably wary of enthusiasm for “cures” that, appearing to treat women’s hormonal complexity as both disease and commercial opportunity, later prove flawed.

Many women know someone who has in fact suffered bad effects from osteoporosis drugs, and that treatment can look disturbingly like one more commercial medical experiment — one from which they may choose to opt out.

ANN F. MILLER

Malvern, Pa.

To the Editor:

As a practicing obstetrician-gynecologist for 20 years, I saw firsthand how fear could be a very real factor in patient decision-making.

Bisphosphonates are drugs that reduce osteoporotic fractures by suppressing bone turnover at a higher rate than normal. In rare cases, overpowering this natural remodeling process can lead to poor healing and some bone becoming more prone to fractures.

Following the reports of such complications, there was a 50 percent decline in bisphosphonates use. Likewise, in 2002, after a major study on hormone therapy reported greater risk of breast cancer, about 80 percent of women discontinued hormones.

Consequently, we are now in the midst of a “bone void”: Patients are simply opting out of effective treatment options, taking chances with a debilitating and preventable condition.

Ideally, medications that restore bone balance in postmenopausal women could pose less risk for bone and jaw problems. Drugs that address osteoporosis, allay fears of breast cancer, treat symptoms and avoid unintended consequences would be a great advance. Hopefully, with the collaboration of patients, clinicians and researchers, we will ultimately get the bone balance right.

DAVID J. PORTMAN

Columbus, Ohio

The writer, director emeritus of the Columbus Center for Women’s Health Research, is the founder and chief executive of Sermonix Pharmaceuticals.