foodconsumer.org: Osteoporosis: Is Treatment Worse than the Disease?

Osteoporosis: Is Treatment Worse than the Disease?
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Laura Lamp King on 09/03/2010 02:12:00
 
As many as 10 million Americans have osteoporosis and 34 million more have low
bone mass, called osteopenia, says the National Osteoporosis Foundation.
Popular osteoporosis drugs Actonel, Boniva and Fosamax, containing oral
Bisphosphonates, may be associated with doubling the risk of esophageal cancer
if used long-term.  Bisphosphonates decrease the number and activity of bone
cells (osteoclasts) to reduce the breakdown of bone tissue.  Following
bisphosphonate therapy, bone has a more normal structure
Early last month Great Britain's General Practice Research Database reported no
increase in esophageal cancer rates in patients treated with bisphosphonates. 
Jane Green, MD, Epidemiologist,  University of Oxford in England, and colleagues
explained the discrepancy between the two British studies of the same database
records could be due to the observation time prior to diagnosis in the first
analysis which was 4 1/2 years versus the second study which was 7 3/4 years.
"Our study thus had the potential to include people with longer durations of
bisphosphonate use and also had greater statistical power," Green and colleagues
asserted.
Suspicions between a possible relationship between bisphosphonates and
esophageal cancer first came to light with the publication of an FDA report 1
1/2 years ago in which 23 cases of esophogeal cancer was diagnosed in Fosamax
users in the US between 1995 and 2008.  In addition, 31 cases of esophageal
cancer using bisphosphonate users in Europe and Japan.
The most recent study involved 2,000 patients with stomach cancer, 3,000
patients with esophageal cancer and 10,600 patients with colorectal cancer all
diagnosed between 1995 - 2005. Each cancer case was compared with five people
without cancer matched for age and sex.
Reportedly, there was no increase in stomach or colorectal cancers, however the
risk for esophageal cancer with five or more years of bisphosphonate use was
nearly doubled.
Diane K. Wysowski, PhD., Epidemiologist, Food and Drug Administration (FDA) was
the first to report esophageal cancer cases in 23 patients using Fosamax in the
US.  She reports that 34 cases of esophageal cancer linked with bisphosphonates
have now been reported to the FDA.
Wysowski suggests that physicians consider the possibility of esophageal damage
when prescribing the drugs and, when talking to patients, reiterate the
importance of following the label directions for taking these drugs, which
minimize the drugs' direct contact with the esophageal tract.  Additionally,
patients should report difficulty swallowing, chest pain, heartburn or other
gastrointestinal symptoms promptly to their health care professional.
WebMD explains, "Bones continually change throughout your life, with some bone
cells dissolving and new bone cells growing back in a process called remodeling.
With this lifelong turnover of bone cells, you replace most of your skeleton
every 10 years.  But for people with osteoporosis -- a thinning of the bones --
bone loss outpaces the growth of new bone. Bones become porous, brittle, and
prone to fracture."
Medical conditions which can lead to osteoporosis are Type 1 Diabetes, Lupus,
Rheumatoid Arthritis, Hyperthyroidism, Celiac Disease, Asthma and Multiple
Sclerosis.
"The most common cause of osteoporosis is estrogen deficiency in women," says
Paul Mystkowski, MD, Endocrinologist, Virginia Mason Medical Center, Seattle and
Clinical Faculty Member, University of Washington, Seattle.  "Bone loss
accelerates after menopause, when older women have a quick drop in estrogen.
Over time, the risk of osteoporosis and fracture increases as older women lose
more bone than they replace."
Mystkowski asserts, that men need both testosterone and estrogen for bone health
because men convert testosterone into bone-preserving estrogen.
Other factors which can lead to osteoporosis are hormone imbalances, lack of
Calcium and/or Vitamin D, a sedentary lifestyle, thyroid conditions, smoking,
certain medical conditions and medications as well as too much alcohol.
Osteoporosis is often a silent disease -- you don't know your bones are weak
until you break one.  Discuss with your doctor what your risk factor is and the
steps you can take to minimize damage and reduce bone loss.