Osteoporosis Medications... Are They Worth the Risk?

I was reading an excellent research article prepared by Dr. Susan Ott, Professor of the Department of Medicine at the University of Washington, Seattle. Dr. Ott is a foremost authority on the diagnosis, treatment and management of osteoporosis.

Her article entitled, What is the Optimal Duration of Bisphosphonate Therapy? was a clear and concise discussion of the benefits and risks of a class of osteoporosis medications called the bisphosphonates.

You may not recognize the medications by this name but you certainly are familiar with Fosomax, Actonel, Boniva and Reclast. Dr. Ott says, "As with any drugs, bisphosphonates should not be used indiscriminately. They are indicated for patients at high risk of fracture, especially those with vertebral fractures or a hip bone density T score lower than –2.5."

But unfortunately, these medications are being prescribed for many more patients than they were initially intended.The risk associated with over-prescription is that these drugs can carry serious side effects that include atypical femur fractures and jaw osteonecrosis.

Because of the way these medications work, long-term use (over 5 years) tends to create bones that are denser but also substantially more brittle. In some ways, extended use of the bisphosphonates contributes to the very problem they are trying to solve. 

Here are some additional highlights of the report. I have attached the entire article
for those of you who might be interested. Feel free to send your questions or comments once you have read the entire report.

• "Reports of adverse effects with prolonged use have caused concern about the long-term safety of this class of drugs. This is particularly important because these drugs are retained in the skeleton longer than 10 years, because there are physiologic reasons why excessive bisphosphonate-induced inhibition of bone turnover could be damaging, and because many healthy postmenopausal women have been prescribed bisphosphonates in the hope of preventing fractures that are not expected to occur for 20 to 30 years."

• "Another common misunderstanding is that the bone density increases because the drugs are “building bone.” After 3 years, the bone density in the femur reaches a plateau. I have seen patients who were very worried because their bone density was no longer increasing, and their physicians did not realize that this is the expected pattern."

• "A study of 50 women treated with bisphosphonates for 6.5 years found that 33 percent had a mineralizing surface of zero. This means that patients taking bisphosphonates are forming very little new bone, and one third of them are not forming any new bone."

• "But bisphosphonates may have long-term negative effects. One purpose of bone remodeling is to refresh the bone and to repair the microscopic damage that accumulates within any structure. Without remodeling, cracks can accumulate. Because the development and repair of micro-cracks is complex, it is difficult to predict what will happen with long-term bisphosphonate use."

For osteoporosis, medication is certainly one option but there are many others that are safer and more effective. On April 25 at 10 am, The Shepherd Center and I will be co-hosting a free lecture entitled, Osteoporosis, There is Something You Can Do About It. Please contact me at woody@sequoiahealth.com for more information and reservations.