The use of ordinary pain medications may suppress the maximum effectiveness of osteoporotic drugs, according to recent analysis.
A recent analysis of data from a single-center, randomized study evaluating the use of bisphosphonate, clodronate, in older women, the results of the study showed that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) blunted most of the observed benefits of clodronate on reducing the risk of fractures in these patients.
“We need to exercise some caution in extrapolating these data to more widely used bisphosphonates in osteoporosis, but given that concomitant use of NSAIDs and bisphosphonates is relatively common, this can have serious clinical consequences and lead to failure to reduce the risk of fractures as we hoped, ”said senior author Eugene McCloskey, PhD, of Northern General Hospital, UK.
Current data cause conflicting confusion about the effects of NSAIDs on the risk of fractures. With previous research providing evidence of both positive and detrimental effects, McCloskey and a team of fellow researchers sought to assess how co-administration of NSAIDs could affect the efficacy of clodronate in a group of older women living in the community.
The pilot study used as the basis for the analysis was a single-center, prospective, randomized, placebo-controlled study of clodronate 800 mg in women living in the community aged 75 years or older, aimed at evaluating the effectiveness of fracture risk reduction intervention . At the end of the 3-year study, clodronate treatment was associated with a 23% reduction in the risk of osteoporotic fracture.
In total, the study provided researchers with data on 5,212 women for inclusion in their analyzes, including 1,082 who reported NSAID use at baseline. Compared to their NSAID-free counterparts, those reporting NSAID use were significantly younger (79 vs. 80 years, P = .004), heavier (mean 66.7 vs. 64.7 kg; P <.001). ) and have a higher cervical femur. mineral density (FN-BMD, 0.66 vs. 0.64 g / cm2; P <.001).
In corrected models, NSAID use was associated with a significant increase in the risk of osteoporotic fractures during the 3-year study period (HR, 1.27; [95% CI, 1.01-1.62]; P = .039) among the entire study population, but this increase in risk was not statistically significant among those randomized to placebo therapy (HR, 1.11 [95% CI, 0.81-1.51]). When assessing the impact of NSAID use among those using clodronate, the apparent benefit of clodronate was not observed among those using NSAIDs (HR, 0.95 [955 CI, 0.65-1.41]; P = .081). Compared with those randomized to clodronate without the use of NSAIDs, who still had a significant reduction in the risk of osteoporotic fracture (HR, 0.71 [95% CI, 0.58-0.89]; P = .002).
In analyzes evaluating the change in BMD of the hip at 3 years from baseline, the results showed that the loss of BMD during clodronate therapy was higher among women receiving NSAIDs (total hip: 2.75% vs. 1 , 27%, P = .078; femoral neck: 3.06% vs. 1.12%, P = .028) and the researchers noted that this effect did not differ significantly from that seen in women receiving placebo therapy.
“Although we have found little evidence of NSAID use as a risk factor for incidental osteoporotic fractures in older women living in the community, the observation that NSAID use significantly reduces the ability of clodronate to prevent bone loss and fractures is unique and of great clinical significance. meaning. The apparent reduction in efficacy does not appear to be mediated by imbalances in baseline characteristics or lower compliance, the researchers wrote.
This study, “Potential Adverse Effects of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) on Bisphosphonate Efficacy: A Post-Hawk Study Study from a Randomized Controlled Study of Clodronate,” was published in the Journal of Bone and Mineral Research.
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