Osteoporosis Drugs Might Not Raise Cancer Risk

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Solomon and his co-author have received funding from Amgen, a company with a new osteoporosis drug, denosumab, in the pipeline.

Another large study in the same issue of the journal actually found a reduced risk of esophageal cancer among individuals taking bisphosphonates, and no increased risk for gastric cancer, when compared with a much larger control group. There was no overall increased risk when the two types of cancer were grouped together.

Those authors also reported receiving consulting fees from a variety of large pharmaceutical concerns.

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Several other letters criticized the reliability of the FDA's data.

But the author of the initial report, FDA epidemiologist Diane K. Wysowski, replied in the pages of the journal that the initial report was never meant to be conclusive, but more of an early warning flag. "Although there is uncertainty about whether the use of oral bisphosphonates increases the risk of esophageal cancer, it seemed prudent to disclose the reports, advise against the use of these drugs in patients with Barrett's esophagus, and recommend definitive studies," she wrote.

Wysowski also pointed out that oral bisphosphonates can affect the esophagus in negative ways and so could "plausibly" be associated with an increased risk of esophageal cancer.

The prescribing information for Fosamax, made by Merck & Co., said that people with "certain disorders of the esophagus" should not use the drug.

And, as always, risks should be weighed against benefits.

"Esophageal cancer occurs extremely rarely, thus, while one should be concerned about a potential increase in risk, a doubling of a very, very rare cancer is still a rare event," Solomon stated. "Fractures are not rare events, and bisphosphonates are proven beneficial in many types of patients at reducing fracture risk.

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