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Osteoporosis Drugs: Worth the Risk?

If you are among the 44 million Americans with osteoporosis or osteopenia, you are most likely taking an oral drug containing Bisphosphonates. 

Bisphosphonates, marketed by the names Actonel, Boniva and Fosamax reduce the breakdown of bone tissue by decreasing the number and activity of bone cells (osteoclasts), giving bone a more normal structure.

A new study by the American Society of Bone and Mineral Research task force analyzed 310 osteoporosis patients with a rare form of femur fracture and found that 94% of them had been taking bisphosphonates.

"Based on the report we now feel that there is a definitive relationship between these class of drugs and these fractures, and it's even stronger in those taking those drugs for a long time," said Dr. Elizabeth Shane, a professor of medicine at Columbia University College of Physicians and Surgeons and co-author of the report.

The task force admits they are not certain whether bisphosphonates actually caused the fractures but recommended that the Food and Drug Administration (FDA) create an international registry to track reported cases.  Their report has been published in the Journal of Bone and Mineral Research.

Elizabeth Shane, MD, Professor of Medicine, Columbia University, NYC says, "these thigh fractures are unusual and uncommon, particularly when you view them in the context of more common osteoporosis fractures, such as rib, spine, and arm fractures.  Unusual femur fractures actually comprise less than 1% of all hip and thigh fractures, and less than one-tenth of 1% of patients on these drugs have sustained a fracture like this."

Bones are constantly breaking down and repairing themselves. The bone breakdown process quickens with advancing age, and if bone rebuilding can't keep up, bones may become brittle and more prone to fracture.  Bisphosphonates slow the bone breakdown process and are taken by millions of patients.

Shane cautions, "We don't want patients or doctors to be afraid to prescribe these drugs because they are worried about thigh fractures.  Many, many more fractures are prevented by these drugs than are caused by them."

Symptoms to be aware of are pain in the thigh or grown in one or both legs and warrant a visit to the doctor.  X-rays may be required for both legs.  Orthopedic surgeons have begun seeing these fractures around the country and are emphasizing that patients taking these drugs visit with their doctor at least one a year and report thigh pain.

"There is promising research on markers of bone turnover which may help identify people who are at highest risk for these fractures before they start exhibiting symptoms," remarked Linda A Russell, MD, Assistant Professor of Medicine, Weill Medical College, Cornell University.

David Burr, Professor of Anatomy and Cell Biology, Indiana University School of Medicine and co-author of the task force report concurs with Dr. Shane that bisphosphonates "prevent many more fractures than they possibly create."

One out of every three women who lives to age 90 will break a hip because of osteoporosis. Men are also vulnerable.  Things you can do to prevent osteoporosis and avoid painful fractures; make sure you get plenty of calcium in your daily diet from both foods and supplements; check your osteoporosis risk factors and change those you can control; get plenty of daily exercise.

Weight-bearing exercises stimulate the cells that make new bone. By increasing weight-bearing exercises, you encourage your body to form more bone. This can delay or even reverse the destructive process of osteoporosis that results in painful or debilitating fractures. By adding strength training to your exercise, you improve your muscle strength and flexibility and reduce the likelihood of falling.

Having the strongest bones possible before you enter menopause is the best protection against debilitating fractures as accelerated bone loss after menopause is a major cause of osteoporosis in women.