The article by Brown et al was entirely unexpected.1 Not because the information provided was ground-breaking, but because it was utterly supportive of bisphosphonate therapy in primary prevention of fractures in women who do not have very low bone density. This is despite high-quality reviews performed by the Cochrane Collaboration, the Therapeutics Initiative, and other specialized evidence-based medicine (EBM) groups. As far as I can tell from these highly regarded groups, the evidence points to not using bisphosphonates for primary prevention unless a patient has very low bone density. As for secondary prevention, the evidence clearly points to a marginal but statistically significant benefit when the benefits outweigh the harms.
The information and methods used to perform this review included many trials that had clear bias and inconsistent data; they also minimized harm while falsely inflating the suggestion of benefit. I believe this likely points to the underuse of properly trained researchers able to synthesize an accurate review of the available information (that is, statistical consultants or co-authors).
Furthermore, there is reason to suspect substantial author bias, given that nearly every author of this paper received funding or has been a speaker or presenter for either Merck or (but most often, “and”) Novartis.
This was a supremely disappointing article, as many family physicians might be led down the path of “pseudo” or sham EBM with the sincere desire to practise unadulterated or true EBM.
I implore Canadian Family Physician to set a higher standard to prevent publication of purported reviews such as this one.
Footnotes
Competing interests
None declared
- Copyright© the College of Family Physicians of Canada
Reference
- 1.↵