NEW YORK (Reuters Health) - In terms of preventing fractures, there is little to choose between commonly used drugs for treating the bone-thinning disease osteoporosis, a study published this week suggests.

Dr. Suzanne M. Cadarette, from Brigham and Women's Hospital, Boston, and colleagues compared fractures occurring within 12 months of starting osteoporosis drug therapy in 43,135 Medicare beneficiaries. The average age of the subjects was 79 years, and 96 percent were women, the researchers note in the Annals of Internal Medicine.

Drugs used were calcitonin administered nasally, raloxifene (brand name, Evista), alendronate (Fosamax) or risedronate (Actonel).

A total of 1051 non-vertebral fractures occurred, and according to the researchers, there were no marked differences in fracture risk between alendronate, risedronate or raloxifene.

However, among subjects with a previous fracture, those taking raloxifene experienced more non-vertebral fractures within 12 months of initiation of therapy than those taking alendronate.

The subjects who were treated with nasal calcitonin also experienced more non-vertebral fractures than subjects who received alendronate.

"There probably is no single clearly superior drug therapy for osteoporosis," note the journal editors. They point out, however, that no adherence data were available.

In a related commentary, Dr. Saul Malozowski of the National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda, says what's needed are head-to-head comparative trials of these agents.

"The U.S. government has already paid for anti-osteoporosis drugs for thousands of patients, despite weak evidence about which are the most effective," Malozowski writes.

"I propose that we devise an ethical way to prospectively randomly assign patients to different (and apparently equivalent) drug regimens and measure the outcomes of treatment, potential adverse events, drug interactions, and costs," he continued. "I assert that if the government pays for tests or treatments, it has an obligation to evaluate them relative to one another."

SOURCE: Annals of Internal Medicine, May 6, 2008.

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