Doctors kill again: bisphosphates and cancer – yet another iatrogenic illness

Dr. Weeks’ Comment:   here at the Weeks Clinic, we routinely increase healthy bone mass and strength and flexibility (i.e.  reduce risk of fracture) in a three-fold manner:   FIRST OF ALL,  we stop the bone destroying habits by increasing weight bearing exercise, reducing junk food (soda pop rich in phosphates, coffee in excess, sugar which poisons cellular regeneration etc.)  SECONDLY  we use naturally occurring bone support materials  (bioavailable calcium, magnesium, boron, zinc, strontium, vitamin B6, vitamin D3 etc.) and THIRDLY  by  directing these nutrients to the task of bone building by using natural hormones like progesterone and DHEA.   All safe. All natural.  No risk of the most deadly of cancers: esophageal cancer.  And we end up with a spry, active elderly population hammering away at each other on the tennis court or courting each other on the dance floor.   Remember: osteoporosis is not caused by a deficiency of bisphosphate drugs (which function by poisoning the osteoclast cells)  just like depression is not caused by a deficiency of SSRI  drugs and the reason you might be cancer free as you read this is not due to your taking your daily dose of chemotoxic cancer drugs.  Health, after all,  is a balance of the right stuff – the stuff you are made of! – not simply ingesting adequate levels of synthetic drugs.

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Long Term Use of Oral Bisphosphonates May Double Risk of Esophageal Cancer, Study Finds

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ScienceDaily (Sep. 2, 2010) — People who take oral bisphosphonates for bone disease over five years may be doubling their risk of developing oesophageal cancer (cancer of the gullet), according to a new study published online in the British Medical Journal.

Oral bisphosphonates are a type of drug used to treat osteoporosis and other bone diseases and are the most commonly recommended treatment for such conditions.

Case reports suggest an association between use of oral bisphosphonates for osteoporosis and increased risk of oesophageal cancer. But the evidence is limited, and no adequately large study with information on potential confounding factors and long follow-up has been published.

So researchers from the University of Oxford’s Cancer Epidemiology Unit and the Medicines and Healthcare products Regulatory Agency carried out a large-scale study to look into the possibility of an association.

They analysed data from the UK General Practice Research Database, which has anonymised patient records for around six million people registered with a NHS GP.

They focused on men and women aged over 40 years — 2,954 with oesophageal cancer, 2,018 with stomach cancer and 10,641 with colorectal (bowel) cancer diagnosed between 1995 and 2005. Each case was compared with five controls matched for age, sex, general practice and observation period.

They found that people with 10 or more prescriptions, or with prescriptions over about five years, had nearly double the risk of oesophageal cancer compared with people with no bisphosphonate prescriptions.

There was no such increased risk for stomach or bowel cancer.

Typically, oesophageal cancer develops in one per 1000 people at age 60-79 over five years. Based on their findings, the authors estimate that with five years’ use of oral bisphosphonates this would increase to two cases per 1000 people taking bisphosphonates over five years.

Although these results appear to contradict another recently published study using the same database, which reported no increased risk of oesophageal cancer with oral bisphosphonate use, this latest report tracked patients for nearly twice as long, and also had greater statistical power.

The study’s lead author, Dr Jane Green, says: “Oesophageal cancer is uncommon. The increased risks we found were in people who used oral bisphosphonates for about five years, and even if our results are confirmed, few people taking bisphosphonates are likely to develop oesophageal cancer as a result of taking these drugs. Our findings are part of a wider picture. Bisphosphonates are being increasingly prescribed to prevent fractures, and what is lacking is reliable information on the benefits and risks of their use in the long term.”

In an accompanying editorial, Dr Diane Wysowski, an epidemiologist at the US Food and Drug Administration, discusses the differences between the two studies. She says that “the possibility of adverse effects on the oesophagus should prompt doctors who prescribe these drugs to consider risks versus benefits.” She also suggests doctors “tell patients to report difficulty in swallowing and throat, chest, or digestive discomfort so that they can be promptly evaluated and possibly advised to discontinue the drug.”

AND THE REBUTTAL

Drugs Used to Treat Osteoporosis Not Linked With Higher Risk of Esophageal Cancer

ScienceDaily (Sep. 3, 2010) — Although some reports have suggested a link between the use of oral bisphosphonates (drugs that prevent the loss of bone mass) and esophageal cancer, analysis of medical data from more than 80,000 patients in the United Kingdom found that use of these drugs was not significantly associated with new cases of esophageal or gastric cancer, according to a study in the August 11 issue of JAMA.

Bisphosphonates are mainly used to prevent or treat osteoporosis, especially in postmenopausal women. Their use has increased dramatically in recent years in the United States and other Western populations, and are now commonly prescribed in elderly women, according to background information in the article. “Esophagitis [inflammation of the esophagus] is a known adverse effect of bisphosphonate use, and recent reports suggest a link between bisphosphonate use and esophageal cancer, but this has not been robustly investigated,” the authors write. “Large studies with appropriate comparison groups, adequate follow-up, robust characterization of bisphosphonate exposure, and information on relevant confounders are required to determine whether bisphosphonates increase esophageal cancer risk.”

Chris R. Cardwell, Ph.D., of Queen’s University Belfast, United Kingdom, and colleagues investigated the association between bisphosphonate use and esophageal cancer by extracting data from the UK General Practice Research Database of patients treated with oral bisphosphonates, along with a group of patients not treated with these drugs (control cohort), between January 1996 and December 2006. Average follow-up time was 4.5 and 4.4 years in the bisphosphonate and control cohorts, respectively.

Excluding patients with less than 6 months follow-up, there were 41,826 members in each group (81 percent women; average age, 70.0 years). One hundred sixteen esophageal or gastric cancers (79 esophageal) occurred in the bisphosphonate cohort and 115 (72 esophageal) in the control cohort. Analysis of the incidence of these cancers among the bisphosphonate and control groups found no difference in risk of esophageal and gastric cancer combined between the cohorts for any bisphosphonate use or risk of esophageal cancer only. There also was no difference in risk of esophageal or gastric cancer by duration of bisphosphonate intake.

“In conclusion, in the UK GPRD patient population we found no evidence for a substantially increased risk of esophageal (or gastric) cancer in persons using oral bisphosphonates. These drugs should not be withheld, on the basis of possible esophageal cancer risk, from patients with a genuine clinical indication for their use,” the authors write.

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