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Drug treatment has little effect on hip fracture risk and may be a waste of money

The current focus on drug treatments to prevent hip fractures is neither viable as a public health strategy nor cost effective, suggests an analysis of the evidence by an international team of researchers.

Before the 1980s, osteoporosis was diagnosed after a bone fracture. But in 1994 a new definition based on low bone mineral density was introduced to identify people believed likely to benefit from bone-building drugs. Fracture risk calculators now classify 72% of white women in the United States as candidates for long-term drug treatment; 93% of those aged over 75 years come into this category. Yet rates of hip fracture have fallen steadily in most Western countries, regardless of access to drugs.

Most hip fractures have little to do with osteoporosis, but rather are caused by falls in frail older adults, say the authors of the new study. Evidence on the cost effectiveness of drug treatment is completely lacking, they add, while the focus on drug treatments means that feasible alternative strategies, such as interventions to encourage physical activity, are overlooked.

They also point to the harm from overdiagnosis and treatment, including the adverse drug effects such as nausea, vomiting and serious bone complications.

Recent evidence also challenges the justification for the general use of calcium and vitamin D supplements to prevent fractures, say the authors.

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