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Osteoporosis Drugs May Be Risky For Bones

The cost of osteoporosis in the U.S. is estimated at $22 billion per year.1 Bisphosphonates (such as Fosamax, Boniva, Actonel, and Reclast) are commonly prescribed by physicians to treat osteoporosis or to prevent osteoporosis in individuals with osteopenia. Unfortunately, bisphosphonates may actually increase one?s risk of mid-femur fractures (the femur is your upper leg bone).

Bone tissue undergoes a continuous cycle of breaking down old bone and rebuilding new stronger bone. Bisphosphonates increase bone mineral density in the short term by reducing bone breakdown, essentially reducing bone loss. However, this is not the same as building natural, healthy bone with exercise. When old bone is not broken down to create new bone, the old bone becomes brittle and fractures easily.

  • In individuals with osteopenia, bisphosphonates increased the risk of hip fracture by 85% and wrist fractures by 50%.2
  • Long term (4-8 years) users of bisphosphonates have significantly higher risks of atypical hip and leg fractures.3 Most of these fractures are not the result of falls. They occur under minimal stress, often merely walking down stairs or low-energy exercise.4
  • An 8-year study of over 88,000 people found that taking bisphosphonates tripled the risk of developing bone necrosis ? this means that bisphosphonates caused permanent loss of blood supply to bone, resulting in tissue death.5

Bisphosphonates have been linked with many other side effects, including esophagitis, esophageal cancer, osteonecrosis of the jaw, and atrial fibrillation. They can also negatively affect the musculoskeletal system, gastrointestinal tract, and kidney function.6

Prevention and treatment of osteoporosis does not need to involve potentially dangerous drugs. Instead, osteoporosis should be prevented and treated through physical exercise and proper nutrition, which have been shown to be more effective than drugs and have no negative side effects.7

 


References:
1. Blume SW, Curtis JR. Medical costs of osteoporosis in the elderly Medicare population. Osteoporos Int. 2010 Dec 17.
2. Abramson J. Overdosed America. Harper 2004; 215.
3. Cermak K, Shumelinsky F, Alexiou J, et al. Case Reports: Subtrochanteric Femoral Stress Fractures after Prolonged Alendronate Therapy. Clin Orthop Relat Res. 2009 Dec 18.
Capeci CM, Tejwani NC. Bilateral low-energy simultaneous or sequential femoral fractures in patients on long-term alendronate therapy. J Bone Joint Surg Am. 2009 Nov;91(11):2556-61.
Goddard MS, Reid KR, Johnston JC, Khanuja HS. Atraumatic bilateral femur fracture in long-term bisphosphonate use. Orthopedics. 2009 Aug;32(8).
Ing-Lorenzini K, Desmeules J, Plachta O, et al. Low-energy femoral fractures associated with the long-term use of bisphosphonates: a case series from a Swiss university hospital. Drug Saf. 2009;32(9):775-85.
Lenart BA, Lorich DG, Lane JM. Atypical fractures of the femoral diaphysis in postmenopausal women taking alendronate. N Engl J Med. 2008 Mar 20;358(12):1304-6.
Sayed-Noor AS, Sjoden GO. Case reports: two femoral insufficiency fractures after long-term alendronate therapy. Clin Orthop Relat Res. 2009 Jul;467(7):1921-6.
Neviaser AS, Lane JM, Lenart BA, et al. Low-energy femoral shaft fractures associated with alendronate use. J Orthop Trauma. 2008 May-Jun;22(5):346-50.
Kwek EB, Goh SK, Koh JS, Png MA, Howe TS. An emerging pattern of subtrochanteric stress fractures: a long-term complication of alendronate therapy? Injury. 2008 Feb;39(2):224-31.
4. Somford MP, Geurts GF, den Teuling JW, et al. Long-Term Alendronate Use Not without Consequences? Int J Rheumatol. 2009;2009:253432.
ABC News: Fosamax: Is Long Term Use of Bone Strengthening Drug Linked to Fractures? http://abcnews.go.com/GMA/OnCall/fosamax-long-term-bone-strengthening-drug-linked-fractures/story?id=10045179
LA Times: Long-term use of popular osteoporosis drug may harm bone. http://latimesblogs.latimes.com/booster_shots/2010/03/bisphosphonates-osteoporosis-medications.html
5. University of British Columbia (2008, January 15). Popular Osteoporosis Drugs Triple Risk Of Painful Bone Necrosis, Study Finds. ScienceDaily. Retrieved February 24, 2011, from http://www.sciencedaily.com? /releases/2008/01/080115092048.htm
6 Bhuriya R, Singh M, Molnar J, Arora R, Khosla S. Bisphosphonate use in women and the risk of atrial fibrillation: a systematic review and meta-analysis. Int J Cardiol. 2010 Jul 23;142(3):213-7.
Sellmeyer DE. Atypical fractures as a potential complication of long-term bisphosphonate therapy. JAMA. 2010 Oct 6;304(13):1480-4.
Pazianas M, Cooper C, Ebetino FH, Russell RG. Long-term treatment with bisphosphonates and their safety in postmenopausal osteoporosis. Ther Clin Risk Manag. 2010 Jul 21;6:325-43.
7. Rubin C, Turner AS, Muller R, et al. Quantity and quality of trabecular bone in the femur are enhanced by a strongly anabolic, noninvasive mechanical intervention. J Bone Min Res 2002;17:349-357.
Gianetti, Heather. "Researchers show the 'BEST' way to reduce osteoporosis risk." EurkAlert.org. 2006. http://www.eurekalert.org/pub_releases/2006-02/msl-rst020106.php.

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