Public reaction to inaccurate media reports covering the risk of osteonecrosis of the jaw in patients taking bisphosphonates led to a fall in prescribing, resulting in additional fractures and even deaths, according to Australian researchers.

The case highlights the challenges of communicating treatment risks to the public without causing alarmist reactions.

Researchers followed trends in the number of prescriptions filled for bisphosphonates nine months after a 2007 ABC TV report raised concerns about the risk of osteonecrosis.

The national broadcaster later acknowledged that the report contained inaccuracies, but not before the issue had received broad coverage from other electronic and print media nationally.

Modelled estimates of the impact suggest close to 10 000 patients were affected, representing 3.1% of the average number of people receiving antiresorptive therapy in 2007, the authors wrote.

“We estimated that 70 hip fractures, 60 other fractures and 14 deaths would have been prevented if the 9878 people affected by the media coverage had taken antiresorptive drug treatment,” they said.

The authors, including rheumatologists Professor Philip Sambrook and Dr Lyn March from Royal North Shore Hospital in Sydney, said the media reports failed to clearly identify the different absolute risk of osteonecrosis in individual patients or the different uses of bisphosphonates in the oncology and osteoporosis settings.

“It behoves the medical community to conduct appropriate studies to gain unbiased assessments of risks, and it behoves media personnel to be more responsible in their reporting so that such alerts first do no harm,” they said.

The incidence of osteonecrosis of the jaw following oral bisphosphonate treatment for osteoporosis is thought to be between 1 in 10 000 and 1 in 100 000 patient treatment years, the authors said, although Australian data have suggested the incidence could be higher.

While the decline in bisphosphonate prescribing has now reversed, the authors said risks need to be kept in perspective and balanced against the demonstrated benefits of fracture reduction and reduced mortality.

MJA 2010; 193: 154-156.
Posted 2 August, 2010

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