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| Dr Karim Khan, who is better known to Canadian Footy fans as a NWPAFL Field umpire, appeared today (19/1/2008) in a Vancouver Sun story |
Sports medicine doctor and researcher Karim Khan works with patient Moira Griffiths, 67, in the exercise suite at Vancouver General Hospital.
(Glenn Baglo, Vancouver Sun)
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Dr Karim Khan is better known to Canadian Footy fans as a NWPAFL Field umpire, appeared today (19/1/2008) in a Vancouver Sun story outlining one of his recent contributions to the world of medicine.
Many osteoporosis drugs taken needlessly
'Don't bank on them,' researcher says
Article written by Jenny Lee, Vancouver Sun (Saturday, January 19, 2008)
Hundreds of thousands of Canadians take osteoporosis medication under the false assumption that the drugs will protect them from breaking bones, a Vancouver bone health researcher says.
Indeed, as many as 99 per cent of Canadians taking the drugs to prevent fracture may be taking them needlessly, says Karim Khan, a researcher at the world-renowned Centre for Hip Health at Vancouver General Hospital.
"They think it's halving their fracture risk, but in reality almost 100 of them have to take medication to prevent one fracture," says Khan, who is also a sports medicine doctor. "The drugs are not that great. Don't bank on them."
(Glenn Baglo, Vancouver Sun)
Bone fractures are best prevented by fall prevention, not osteoporosis medication, says Khan and colleagues whose Finnish-led analysis paper Shifting the Focus in Fracture Prevention from Osteoporosis to Falls was the cover story of the British Medical Journal Friday.
The authors based their recommendations on an analysis of many studies ranging from large consensus statements to smaller community-based studies.
Canadians overestimate the effectiveness of drugs, Khan says.
"Drug companies tell doctors and people these drugs halve the risk of having a fracture, but that's a mathematical trick," says Khan, a University of B.C. associate professor of family practice. If medication drops the risk of fracture from two per cent of the population to one per cent, the true risk actually drops by one percentage point, not 50 per cent.
About 1.4 million Canadians have osteoporosis and about 20 per cent of them are taking medication for the disease. A large number of people who have slightly abnormal bone density, or osteopenia, are also taking the medication.
Currently, physicians screen for osteoporosis then treat with medication, but in practice, the test for osteoporosis can be wildly inaccurate. It can under- or over-estimate bone mineral density by as much as 20 to 50 per cent, or enough to cover a range from clearly osteoporotic to normal, the new analysis paper reports.
At the same time, this bone mineral density test is measuring the wrong thing, Khan says.
Medication will strengthen and build bone, and improve a bone mineral density score, "but the goal isn't to have the biggest bone density score," Khan says, "The goal is to prevent fracture and to do that you need to prevent falls."
"It's not debatable," he says. "Eight in 10 fractures occur in people who do not even have osteoporosis. "
Of all bone fractures, hip fracture is the biggest threat to life, Khan says.
Twenty per cent of people who have a hip fracture die within a year. Half of all people who have a hip fracture must go into assisted living. Falling is the key cause in nine out of 10 hip fractures.
Osteoporosis medication is not only relatively expensive and commonly causes stomach discomfort, taking it may give people a false sense of security, Khan says.
"If people think they are getting immunity by taking the drug, it's much easier to say falls prevention exercises don't matter and hip protectors don't matter."
Hip fracture rates have started dropping in B.C. over the past three years, particularly in residential care and in hospitals, because of heightened awareness of high risk situations for falls and greater use of hip protectors, says Bonnie Lillies, leader of the Seniors Falls and Injury Prevention Initiative at Vancouver Coastal Health.
Should you be taking osteoporosis medication?
- If you have had a fracture or are over 75, you definitely want to take osteoporosis medication, Khan says. The medication will strengthen bones, build new bone and reduce the risk of fracture because drug effectiveness is much higher among high risk groups.
The risks of bone necrosis, or painful crumbling of bone tissue, for most patients taking bisphosphonates -- the most common osteoporosis drugs -- is extremely low at about one in a 100,000, Khan says.
- If you are in your 50s or early 60s and otherwise healthy, know that at your age, well over 100 people need to take the medication to prevent one fracture, Khan says.
"To me, that doesn't make sense," Khan says, "but if you're 75, we only need to treat 30 people to prevent one fracture, so that makes sense."
Discuss your medication with your physician.
How to prevent fractures
- Even skiers, mountain bikers and bicycle commuters should actively protect themselves from falls because the effects of hip fracture are so devastating.
Hip protectors are relatively inexpensive and do not show under clothing.
"I wear a hip protector when biking in the winter because of ice," says Khan, a bike commuter. "I know someone who broke a hip on the bike."
- Do regular strength and balance training.
- Take vitamin D and calcium supplements.
- Assess and rectify possible fall hazards at home. Install anti-slip devices.
- Be aware that a fall in the previous 12 months gives you two to three times greater risk of a future fall; an indoor fall predicts future falls more than an outdoor fall; and inability to get up after a fall increases future risk of falls five-fold.
jennylee@png. canwest.com
Article received from Stuart Grills (BCFooty)
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Posted on Jan 22, 2008 20:56pm by admin
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