JAMA 27 Dec 2006

While you are reading this, amoeba-like cells are crawling over your bones and eating them away. Unless, that is, you are taking a bisphosphonate to paralyze your osteoclasts and leave your osteoblasts to lay down new bone unhindered. The FIT study, which was published ten years ago, showed that daily alendronate for 3-5 years is safe and prevents osteoporotic fractures; but until this follow-on study (FLEX) we didn’t know what to do after that. Should we stop treatment at five years, knowing that bisphosphonates are highly bound to hydroxyapatite in bone and continue to work for ages after being stopped? Is there a risk of cumulative microfractures if we continue to use them? For the answers, it’s best to go straight to the editorial , since the paper itself can be a very confusing read. Essentially, there is no evidence that continuing alendronate after the first five years does any good or any harm.

O little town of Framingham, how still we see thee produce new data. This week it’s about stroke over the last fifty years, and it’s a mixed story. Lifetime risk of stoke has only declined modestly in that time, since improvements in prevention seem mainly to have postponed rather than eliminated these events; outcome at 30 days has improved in men but not in women.

While you are reading this, cells inside you are pumping out protons and chlorine ions and filling your stomach with hydrochloric acid. Unless, that is, you have gastric atrophy or are taking a proton pump inhibitor, like millions of middle-aged Britons. When these drugs first appeared, we worried that their miraculous symptom-relieving properties might hide serious long-term dangers to the GI tract. These have not materialised, but this study using the UK GP Research Database comes up with worrying evidence of a dose-related increase in risk of hip fracture in people taking PPIs for more than a year.