{"id":78,"date":"2007-01-02T12:49:40","date_gmt":"2007-01-02T11:49:40","guid":{"rendered":"http:\/\/resource.bmj.com\/bmj\/2007\/01\/02\/jama-27-dec-2006\/"},"modified":"2007-01-02T12:49:40","modified_gmt":"2007-01-02T11:49:40","slug":"jama-27-dec-2006","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2007\/01\/02\/jama-27-dec-2006\/","title":{"rendered":"JAMA 27 Dec 2006"},"content":{"rendered":"<p>While you are reading this, amoeba-like cells are crawling over your bones and eating them away. Unless, that is, you are taking a <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/full\/296\/24\/2927\">bisphosphonate <\/a>to paralyze your osteoclasts and leave your osteoblasts to lay down new bone unhindered. <!--more-->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 <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/full\/296\/24\/2927\">follow-on study (FLEX)<\/a> we didn\u2019t know what to do after that. Should we <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/full\/296\/24\/2927\">stop treatment at five years<\/a>, 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\u2019s best to go straight to the <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/full\/296\/24\/2968\">editorial <\/a>, since the <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/full\/296\/24\/2927\">paper <\/a>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.<\/p>\n<p>O little town of Framingham, how still we see thee produce new <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/full\/296\/24\/2939\">data<\/a>. This week it\u2019s about <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/full\/296\/24\/2939\">stroke <\/a><a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/full\/296\/24\/2939\">over the last fifty years<\/a>, and it\u2019s 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.<\/p>\n<p>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 <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/full\/296\/24\/2947\">proton pump inhibitor<\/a>, 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 <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/full\/296\/24\/2947\">study <\/a>using the UK GP Research Database comes up with worrying evidence of a dose-related increase in risk of <a href=\"http:\/\/jama.ama-assn.org\/cgi\/content\/full\/296\/24\/2947\">hip fracture<\/a> in people taking PPIs for more than a year.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>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 [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2007\/01\/02\/jama-27-dec-2006\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":38363,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[111],"tags":[],"class_list":["post-78","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-richard-lehmans-weekly-review-of-medical-journals"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>JAMA 27 Dec 2006 - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2007\/01\/02\/jama-27-dec-2006\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"JAMA 27 Dec 2006 - The BMJ\" \/>\n<meta property=\"og:description\" content=\"While you are reading this, amoeba-like cells are crawling over your bones and eating them away. 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