Almost as if on cue, Natasha Singer of the New York Times has placed a long, careful and well-balanced article in tomorrow's edition of the paper, as Merck readies its defense, in the Graves case (now concluding the halftime intermission -- as I wrote earlier, this very night). Do go read it all -- very well done -- but here is a bit:
. . . ."As the field has evolved, we have learned that bisphosphonates don’t seem to reduce the fracture risk in people who are not at high risk for fracture," Dr. [Elizabeth Shane, a professor of medicine at Columbia University College of Physicians and Surgeons] said.
As for long-term use of the drugs in light of some recent reports in medical journals about rare problems like jawbone death and unusual thigh fractures, Dr. Rosenblatt [Chief Medical Officer of Merck] said there was not enough evidence to conclude that the drugs caused the conditions. . . .
Dr. Seton of Massachusetts General, who is not involved in any of the lawsuits, the unusual jaw and thigh conditions pose a mystery. She theorized that perhaps these rare cases might be occurring in a small subset of patients whose bodies absorb the drugs in a different way or whose bones have unique qualities that increase their risk for such problems. Two of her patients on bisphosphonates suffered the atypical thigh bone breaks, she said."While I think the benefits outweigh the risks in the elderly population being treated for osteoporosis, I’m not sure that that is so clear for a younger person or those with osteopenia," Dr. Seton said, adding that she takes postmenopausal patients off the drugs after three to five years.
"I have great humility for what we don’t know," Dr. Seton said. "And I don’t know that more bisphosphonates will prevent more fractures. . . ."
This is a compassionate, level headed look at the Fosamax conundrum. We'll keep you posted on trial developments.
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