This thorough, well-researched story focuses on the debate over how and whether bisphosphonates should be used to treat osteoporosis, and provides a general overview of the related risks and potential benefits. The story does many things well — and addresses cost, potential conflicts of interest, and disease mongering particularly well. However, the story cites benefit numbers from a recent New England Journal of Medicine paper without giving readers any information about the study or where those numbers came from. Providing more context on those benefit numbers would have made the story stronger.
Osteoporosis is not uncommon. Estimates of osteoporosis occurrence (and severity) vary, but a 2014 study estimated that more than 10 million people in the U.S. have osteoporosis. Osteoporosis increases the risk of bone injuries, such as hip fractures, that can have significant impacts on a patient’s health and quality of life. A 2007 study estimated that 65 percent of women who develop osteoporosis, and 42 percent of men who develop osteoporosis, will suffer a bone fracture in their lifetime. In short, many people will have to make decisions about how to prevent or treat osteoporosis. If there are complicated issues surrounding widely-used treatment options — as is the case with bisphosphonates — there is real value in news stories that attempt to untangle those issues for readers. That also makes it particularly important for such stories to clearly address everything from the financial ties of expert sources to the quality of the evidence tied to health risks and benefits.
The story is clear on this point, stating: “All the bisphosphonates are now available in generic form, for as little as $5 a month.” The only point of confusion is that the story also refers to “newer osteoporosis drugs retailing for hundreds of dollars or more a month.” However, it doesn’t tell us anything else about these drugs, other than their names. (We’ll get back to that in the “Compare Alternatives” section.)
This entire story is essentially about comparing the benefits and risks of bisphosphonate use for treating osteoporosis. The story states early on that “An analysis in the New England Journal of Medicine last month estimated that for every 1,000 women with osteoporosis treated up to five years, bisphosphonates prevented 100 fractures and caused at most 1.” But the story also notes that “Some critics say the new analysis overestimates the benefits and underestimate the number of sudden thigh-bone fractures.” There are some issues with the story handles benefits, but we’ll address that under “Quality of Evidence.” We’d add that as much as we would like there to be simple and incontrovertible answers to questions surrounding benefits and risks, these numbers simply do not exist.
The story mentions potential harms in its lead sentence, referring to “such serious side effects as sudden bone fractures.” As noted above, the entire story is essentially about comparing the benefits and risks of bisphosphonate use for treating osteoporosis. The story does a good job of discussing potential (and serious) side effects such as sudden fracture of the femur and osteonecrosis of the jaw. However, the story doesn’t mention the less serious (but more common) side effects such as heartburn or other gastrointestinal problems.
Despite its overall high-quality coverage, the story earns a borderline Not Satisfactory on this criterion, and here’s why: The third sentence in the story states, “An analysis in the New England Journal of Medicine last month estimated that for every 1,000 women with osteoporosis treated up to five years, bisphosphonates prevented 100 fractures and caused at most 1.” Several paragraphs later, the story notes that “Some critics say the new analysis overestimates the benefits and underestimate the number of sudden thigh-bone fractures.” But this is is all the information the story gives readers about the NEJM paper. The story does tell us that the paper’s lead author consults for bisphosphonate manufacturers, which makes it particularly important to talk about where those benefits numbers come from. Unfortunately, reading the NEJM paper won’t shed much light on that — because the benefits information cited in the story stems from a table that draws on information from various previous journal articles. Most readers simply won’t have the time, the expertise or the access needed to track down and sort through those journal articles in order to determine how reliable that benefits information might be. If a story is going to highlight bold benefits statements, it should offer some insight into where those numbers came from. Similarly, if a story is going to include criticism about those numbers, it should include some discussion of who is leveling the criticism and what the critics claim the benefits and potential harms of the drugs to be.
We liked that, when discussing osteopenia, the story included a quote from an expert that osteopenia “isn’t a disease. It merely tells us that bone density is in the lower part of normal range. There are an awful lot of people who fall into that category who may never get osteoporosis.” Hurray for paragraphs like this one, which help readers understand what a potentially scary medical term actually means and tells them not to panic.
The story incorporates input from several sources, and tells readers precisely what sort of financial ties each source has to relevant drug companies. Kudos.
The story discusses various dietary and lifestyle choices that can affect osteoporosis risk, which is great — and earns the story a “Satisfactory” rating here. However, there is one area where the story may have left readers a little confused. The story says “other osteoporosis drugs have different trade-offs,” but doesn’t tell readers what that means. It also says, “Newer osteoporosis drugs retailing for hundreds of dollars or more a month include Forteo (teriparatide) and Prolia (denosumab)” — but then doesn’t tell readers anything else about the drugs. If the drugs are worth mentioning, it’s also worth explaining what they are, how they may be beneficial, or at least what some of those unnamed trade-offs might be.
It’s clear that bisphosphonates are in widespread use, and the article at least implied that the generic versions were generally available at the low quoted price — giving readers the tools to select the drug and look at reasonable pricing.
The story focuses on an active debate, rather than on a new technique, technology, or drug. There are no claims to novelty, so we’ll rate this as not applicable.
The story clearly goes well beyond what would be found in any news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
Comments (2)
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Pam Tarlow
March 15, 2016 at 9:37 amThank you for this great review. It is so helpful to have examples of good reporting
Alan Cassels
March 17, 2016 at 1:48 pmI suspect we are going to look back on the decades of bisphosphonates as an unmitigated disaster so it’s great to see quality reporting of what is a very controversial, and debatable practice: the medicating of aging bones. I particularly liked the smackdown of ‘osteopenia’ which one could define as: “being at risk for being at risk for having a fracture.”
If journalists are looking for an overview of the effectiveness of a drug class I would ask them to check out TheNNT.com. In this case, a systematic review found “the bisphosphonates do appear to reduce fractures among women with very low BMD and those who have had previous fractures, and should be considered. However in those without very low BMD or fractures no study has demonstrated a true benefit” The “100 in 1,000” fracture prevention seems to be a gross exaggeration. Here’s the link. http://www.thennt.com/nnt/bisphosphonates-for-fracture-prevention-in-post-menopausal-women-without-prior-fractures/
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