New Cautions About Bone-Building Drugs: Are They for You?


Bone-building drugs are being prescribed more and more frequently, for lower levels of bone loss and for younger and younger women (and for men too). At the same time, there is more information coming out about them that suggest we should weigh the pros and cons carefully.

What are osteopenia and osteoporosis?

A bone density test measures bone in various locations in the body. The results are compared to the bone density of average young adults. If the results are 1 to 2.5 standard deviations below the average young adult, then the diagnosis is osteopenia, which means “less bone”. If the result is greater than 2.5 standard deviations, then the diagnosis is osteoporosis, which means “a condition of bone loss”. Because the results are compared to “average young adults”, the bone density test results are much more meaningful when compared to your own previously tested baseline levels.

The majority of bone loss occurs the first 5 years after menopause for women. And men too suffer from bone loss, but generally it happens about 10 years later in life than for women. Use of certain medications can actually increase the rate of bone loss. These include: steroids, like prednisone; antacids; proton pump inhibitors for the treatment of ulcers and acid reflux, such as prevacid, aciphex, prilosec, and protonix; and some chemotherapy drugs. Poor dietary and lifestyle practices can also contribute to bone loss. Excess soda, alcohol, caffeine, protein, sugar and simple carbohydrates can accelerate bone loss. A diet lacking in adequate produce can also accelerate bone loss. A sedentary lifestyle and chronic stress are also contributors.

Often a diagnosis of osteopenia or osteoporosis leads to a prescription for one of the various bisphosphonate drugs, including Fosamax, Boniva, Actonel, Zometa, Reclast, Didronel, Aredia and Skelid. Although there are many well-known potential side effects of these drugs (some quite serious like inflammation or ulceration of the esophagus and increased gastric ulcer risk), many people tolerate them well. However, there is the potential of FOUR additional risks with the use of these drugs that may be of even more concern. They happen to be lesser known and/or recently identified risks.

  1. In January 2008, the FDA released a new warning that this popular class of drugs may lead to severe, chronic and even permanent pain in muscles, joints and bones. And, according to the FDA, many physicians are not aware that these drugs can be causing severe pain in their patients. This pain may occur immediately or after years of use.
  2. A study in the April, 2008 Archives of Internal Medicine, reported that women taking Fosamax have an 86% increased risk of atrial fibrillation, a chronic irregular heartbeat that can be life-threatening.
  3. A rare potential and very serious side effect is osteonecrosis of the jaw, which causes the jawbone to rot and die. Although it is rare, it should raise concern for anyone needing extensive dental work or who already has poor dental health. And, there is no way of knowing who is at risk of developing this serious condition.
  4. A series of case reports of a rare type of leg fracture shearing across the upper thighbone have emerged in people taking these drugs for 5 or more years. These fractures occurred spontaneously, without prior trauma. Are these drugs causing the bone to be weaker in some ways?

Some of these concerns are just emerging and no doubt will lead to some longer term studies of the safety of these drugs. However, I think it’s important to consider all of the potential side effects when considering starting any medication. Like many classes of medications, these tend to be over-prescribed. Certainly these drugs can be life saving for anyone with severe osteoporosis. But what about the woman in her 40s, 50s, or 60s with osteopenia? Do you have a history, personal or family, of atrial fibrillation? Dental issues? What about taking these drugs for many years? Is there a question of starting these drugs too early in some cases? What about balancing the bone density test results with other risk factors? Hopefully, these answers will become clearer over the next few years. In the meantime, each individual has to weigh the benefits and risks for themselves and with the help of their health care practitioners.

Osteoporosis is a serious condition because it can lead to more easily breaking a bone with a fall. If it’s a large bone like the hipbone, the recovery is long and depending on age and general health, some people don’t fully recover from it. There are over 300,000 hip fractures in adult Americans each year. For those with serious osteoporosis and especially with other risk factors, these medications can be life saving.

However, for those with less risk of fractures, there are nutrition and lifestyle strategies that can help maintain healthy bone and slow bone loss. These strategies work best the earlier they are utilized. Even if you choose to use these medications, good nutrition and mineral supplementation can help you protect your bone and perhaps limit the duration of medication use.

There is also a bone resorption urine assay test available. It’s a simple urine test, which measures bone breakdown products in the urine. It can help identify if the bone loss is currently occurring. And, it can be used to evaluate how well your bone-saving plan is working.

I can help you eliminate the “bone-busters” and incorporate the “bone-builders” in your diet and lifestyle. Whether you are starting early to protect your bone, are diagnosed with osteopenia or osteoporosis, and even if you are on a bisphosphonate medication, good balanced nutrition and regular exercise are the best recipe for healthy, strong bones.