The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.
Letter to the Editor
I read your summary of osteoporosis treatment1 with a mixture of interest, and of dismay that I still have to treat 99 patients to prevent one serious fracture.
Without an accompanying analysis of serious adverse effects of the drugs, this does not inspire me to treat my patients at all. But there is another factor that has not been analysed – progress in the orthopaedic treatment and aftercare of fractures. Are there any data to suggest that the rationale for osteoporosis treatment – prevention of large bone fracture – is in fact less than it was in the past due to non-pharmacological advances in medicine?
At what point does the number needed to treat cross the line into ineffectiveness, or the line where the cure is worse than the disease?