The results of a new study looking at falls and fractures among aspirin users are disappointing.
For decades, aspirin has been called a wonder drug. It’s easy to see why; It is a pain reliever. It can lower the temperature. can reduce the risk of stroke and heart attack in people at high risk for cardiovascular problems, and it lowers the risk of some types of cancer. It is cheap, easy to manufacture and widely available without a prescription.
In recent years, research has also linked aspirin use to better bone health and a lower risk of bone fractures after falls (which can have devastating consequences, especially among the elderly). Now, a new study takes a closer look at the potential benefits for bones.
Why would aspirin be good for bones, anyway?
It may seem surprising that aspirin would have any effect on bone health, or fracture risk. But aspirin may encourage the development and survival of bone marrow cells involved in bone formation. It can also inhibit cells that break down bone. In addition, by preventing cardiovascular diseases and strokes, aspirin can reduce weakness and improve general health. This can lead to fewer falls and bone fractures.
A review of multiple studies found that Aspirin use reduces fracture risk by 17%. But the studies included in that review were observer, meaning they could only show an association between aspirin use and lower fracture risk. Such studies cannot prove that aspirin use was the actual reason for fewer fractures.
Better studies are needed to prove or disprove this possibility. Fortunately, one of them has just been published – and it calls into question whether aspirin has any effect on bone health.
Gaining a better understanding of aspirin and bone health
Published in JAMAThe new study is the first randomized, controlled trial to explore a possible association between aspirin use and fracture risk. This type of study is more powerful than an observational study and can help prove whether aspirin use has an effect on fracture risk.
Nearly 17,000 older adults were randomly assigned to receive a low-dose aspirin (100 mg) or an identical placebo daily. They were then monitored for fractures or serious falls over a nearly five-year period. A serious fall was defined as one that led to an emergency room or hospital visit. The average age of the study participants was 74; more than half (55%) were women, and most were white.
The researchers found:
- Serious falls and fractures were common, experienced by 8.6% of those taking aspirin and 9.5% of those taking placebo.
- There was no difference in fracture risk between the aspirin and placebo groups.
- Aspirin users had a significantly higher rate of serious falls. This may be due to the blood-thinning effect of aspirin: an injury that would normally cause only minor bruising or bleeding may require medical attention if a person takes aspirin.
Unlike previous observational studies, these findings do not support the use of low-dose aspirin to improve bone health or reduce fall-related fractures.
What else is important to know about aspirin?
While aspirin may seem like a safe treatment, there are some downsides that adults should consider, including a higher rate of serious falls as noted in this new study. Except this:
- Aspirin and other nonsteroidal anti-inflammatory drugs are a major cause of stomach ulcers and gastrointestinal bleeding.
- Reactions to aspirin can be serious; these include allergic reactions and worsening of respiratory conditions such as sinusitis or asthma.
- The blood-thinning effect of aspirin can cause serious bleeding in a person with certain blood disorders (such as hemophilia), or in someone who is already taking another blood thinner.
- Aspirin therapy to prevent cardiovascular disease has been known for decades. However, the latest research and guidelines now suggest that people do not take aspirin routinely unless they have had a heart attack or stroke, or have other high risks for cardiovascular problems.
Despite aspirin’s reputation as a wonder drug, this latest research is a reminder that aspirin isn’t good for everyone or every condition—even wonder drugs have their limitations. And this new research is just the latest example of how impressive results from observational studies can be unreliable and may not hold up to more powerful studies.
Keep this in mind the next time you read news about a medical treatment, whether it’s a newly discovered drug or a wonderful old over-the-counter drug already in your medicine cabinet.
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