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Osteoporosis, bisphosphonates and how to keep your bones strong

Bisphosphonate drugs, such as Fosamax, are marketed heavily to older adults as a medicine that keeps your bones strong, particularly for people with osteoporosis. Like all drugs, bisphosphonates have side effects. It’s important to know who benefits from bisphosphonate drugs before deciding to take one.

Bisphosphonate drugs treat osteoporosis by decreasing the breakdown (resorption) of bone that is part of bone’s normal remodeling process but that speeds up with age. The FDA approved the first bisphosphonate, Fosamax or alendronate, in 1995. These drugs are marketed heavily to prevent broken bones in older adults.

Osteoporosis is a key reason why a fall can be so catastrophic for an older person. A bone breaks and with the decreased mobility, a downward spiral begins. Hip fractures for example carry about a 25% risk of mortality within a year.

Who do bisphosphonates benefit?

Bisphosphonates are proven to benefit women with very low bone mineral density and women with a history of fractures. Their greatest impact has been on vertebral fractures, although they also have been shown to decrease rates of hip and wrist fractures. To get an idea of the size of the benefit, for every 100 women taking the medicines, six avoided a fracture of some sort over three years of therapy.

Formulations of the bisphosphates exist where the drugs can be taken weekly or monthly, and these are as effective as the ones taken daily. People who take them should continue to take calcium and vitamin D.

Good evidence also exists that the bisphosphonates help with the osteoporosis induced by the use of steroids, which sometimes have to be used for years for the treatment of various chronic inflammatory condition.

Are bisphosphonates overmarketed?

Some authorities believe that drug companies have overmarketed bisphosphonates, and that doctors prescribe  them to too many women who do not have osteoporosis, but “osteopenia,” a condition invented by the pharmaceutical companies. People with osteopenia have a lower bone mineral density than “normal” but not as low as to be diagnosed with osteoporosis. Our bone densities, muscle mass, brain mass, etc, decline with age.

For the ravages of aging, the one best thing anyone can do (perhaps besides not smoking) is to exercise. As millions of women took bisphosphonates, reports multiplied of a rare fracture of the femur, after a patient has been on the drug for five years or so, and also of a rare type of deterioration of bone in the jaw. The latter tended to occur in people with cancer or otherwise suppressed immune systems. (You can read more on Just Care here.)

The evidence is evolving on how long people should take these drugs. After a few years, you should discuss with your doctor whether you should continue, and make sure you understand the risks and continued potential benefits.

Don’t forget calcium and vitamin D

Calcium helps keep your bones strong and healthy. So, it is wise to incorporate foods with calcium, such as milk and yogurt, into your daily diet. If you’re not getting enough calcium, exercise may be your best bet for bone health; as I have explained in another post, the evidence is weak that calcium supplements will benefit you.

Vitamin D supplements also seem to be over-rated as far as bone health, as supplements do not lower fracture risk for those living in the community. It is good to eat salmon and tuna or milk supplemented with vitamin D. For those living in nursing homes on the other hand, they do lower the risk of fractures from falls.

Here’s more from Just Care:


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