The dangerous irony of osteoporosis drugs

What can you say about a drug that often triggers the problem it’s supposed to prevent?

One word: beware!

That’s the unsettling reality of the class of drugs called bisphosphonates, better known by brand names like Fosamax, Boniva, and Actonel.

Bisphosphonates are given mostly to women over 50 who have osteoporosis or low bone mineral density. These drugs build bone, but there’s a catch.

Overproduction of bone building can make bones brittle enough to snap.

So at what point does bisphosphonate use go too far?

To answer that, researchers from Seattle’s University of Washington analyzed four years of medical records for more than 5,100 women who had been taking a bisphosphonate drug for at least two years and no more than 13 years.

Having seen similar studies in the past, I wasn’t surprised at the outcome. Women who had taken the drug for just two years were at less risk of a fracture compared to women who took the drug for 10-13 years.

That’s pretty cut-and-dried, but a closer look at individual fracture categories blurs the lines.

For instance, in the category of “wrist or forearm fracture” the fracture rate in the 2-years group was very close to the rate for the 10-13 year group.

And in the “clinical vertebral fracture” category, rate of fracture in the 6-9 years group was higher than the rate in the 10-13 group.

In other words, how long a bisphosphonate is effective and at what moment it becomes a danger varies from one patient to another.

This a dilemma for many women. They only want to do what’s best for their bones, but with bisphosphonates they’re forced into a game of chicken, not knowing from one week to the next if they should get out while the getting is good, or stay in and hope that protection exceeds risk.

The best first step these patients can take is to find a doctor they trust who’s experienced in treating bone mineral density problems. And in the best case scenario, that doctor will be aware that drugs alone aren’t the solution. Making sure you’re getting the necessary nutrients for bone health is another critical aspect of osteoporosis prevention. And those necessary nutrients go way beyond calcium.

Any supplement regimen to support aging bones also requires magnesium, manganese, vitamin K2, and, of course, vitamin D. Most of these nutrients can be found in calcium-rich foods such as kale, broccoli, bok choy, almonds, watercress, and sardines. In addition, omega-3 fatty acids help your body absorb calcium.

And as with nearly every health issue, exercise is a plus. Physical activity helps keep bones strong, but women at risk of fracture should talk with their doctors about the types of exercise that will best fit their needs.



Specific long-term therapy may not prevent fractures in older women

American Geriatrics Society

June 2, 2017

Long-Term Oral Bisphosphonate Therapy and Fractures in Older Women: The Women’s Health Initiative

Journal of the American Geriatrics Society

May 29, 2017