Wednesday, September 9, 2009
Does FRAX lead to Fosamax?
Advances in osteoporosis treatment (along with some other mystery factor) have meant fewer broken hips, but a new NY Times article argues that clinicians may have gone too far in treating reduced bone density. According to the story, some docs are using the new FRAX diagnostic tool (which we covered in an article about male osteoporosis) to diagnose large numbers of patients with osteopenia. Many of these patients are then being prescribed bone-building drugs despite the lack of evidence for that treatment plan. So you get unnecessary medication side effects and additional health care costs out of what was supposed to be a helpful free tool. Oops.
On the subject of health care costs, an incidental point in the story is interesting. In the ACP Internist article on osteoporosis, experts talked about the unreimbursable expense of DXA scanning. According to the Times, there's a change on that front: drug companies are now paying for doctors' offices to install the scanners in the hopes of selling more osteoporosis drugs.
posted by Stacey Butterfield at
2:53 PM
1 Comments
Tuesday, June 2, 2009
News from Digestive Disease Week: PPIs and CAT
CHICAGO--Is there a link between acid-reducing meds and hip fractures?
A new study released here today reports that taking even less than one proton pump inhibitor (PPI) or histamine-2 receptor antagonist (H2RA) could increase your patients' risk of hip fractures.
Fracture risk rose 12% for those taking less than one pill a day, 30% for those taking the usual dose of one pill a day, and 41% for those taking more than one pill a day among patients studied at the northern California Kaiser Permanente integrated health-services organization. Patients with hip fractures were 30% more likely than controls to have taken PPIs and 18% were more likely to have taken H2RAs for at least two years.
While risk seemed greatest among patients 50-59 years old, the greatest number of fractures was among the 80- to 89-year-old group, which had a lower PPI-relative risk.
"Patients taking acid suppressors should continue treatment at the lowest effective dose. However, they should discuss treatment options with their doctor if they are at risk of osteoporosis," said Douglas A. Corley, MD, of Kaiser Permanente in San Francisco, and the study's lead investigator. The study looked at up to 10 years of exposure to PPIs and H2RAs for 33,752 cases.
New CAT cautions: The risks of giving complex antithrombotic therapy (CAT) to your patients may be higher than you think.
New data released here today shows that veterans aged 60-99 who were prescribed aspirin-antiplatelet therapy or aspirin-anticoagulant therapy were two to two-and-a-half times more likely to suffer significant upper gastrointestinal events (UGIE) like bleeding or perforation. The least harmful CAT combination was anticoagulant-antiplatelet therapy.
However, younger patients (those between ages 60 and 69) who received CAT were at highest risk of experiencing UGIE, and their risk of bleeding within one year of taking the drugs was four times higher. These patients were likely to be on aspirin-anticoagulant-antiplatelet therapy for a history of ischemic heart disease, hypertension, diabetes, and peripheral artery disease.
"The observed magnitude of UGIE risk suggests an unfavorable risk/benefit profile for CAT in the short term," says Neena S. Abraham, MD, lead investigator of the study, conducted with the Michael E. DeBakey VA Medical Center and Baylor College of Medicine in Houston. The study was conducted from Jan. 1, 2003 to Sept. 30, 2006.
--By Paula Katz, special to ACP Internist
Labels: digestive disease week, fractures, ppi
posted by Janet Colwell at
10:00 AM
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ACP Internist hosted Grand Rounds on June 16, wrapping up the best of the medical blogosphere. Click here for the complete wrap-up.
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