I recently read an article about the long term use of Bisphosphonate (Fosamax) and increased fracture risk. Typically Fosamax is typically given to postmenopausal women with osteopenia (osteoporosis) to slow bone loss and to prevent fractures due to osteoporosis. It is noted that several studies have reported a the occurrence of specific and rare types of femur fractures in individuals (mostly women) who have been taking bisphosphonates (Fosamax) for approximately 4-8 years. It should be noted that the fractures occurred with no apparent trauma. These fractures were not from falls. In fact, in most cases, individuals were performing low energy exercise, sometimes just walking down a flight of stairs.
To give some background and technical info, bisphosphonates work by supressing osteoclasts (the cells that break down and recycle bone). The theory is that if you inhibit bone turn-over you will be left with more bone and less net bone loss. However, bisphosphonates accumulate in the bone tissue and stay active for up to 10 years after their consumption is stopped. What you are left with is increased bone density, but the quality of the bone is not not good. When the osteoclast are suppressed the osteoblasts (cell used that form new bone) are also affected. Bone remodeling and turnover is a natural part of maintaining bone health and when bone resorption is decreased, bone formation is also decreased. The microdamage that occurs regularly in bones and is normally repaired accumulates over time and is apparently not repaired because the normal process of bone resorption and formation has been altered by treatment with bisphosphonates. After long term use, the quality of bone is not maintained.
Present conclusion are that during long term alendronate (generic name for Fosamax) therapy, severe suppression of bone turnover may occur, resulting in increased susceptability of nonspinal fractures along with delayed healing. Current evidence suggests that bisphosphonates should be stopped after 5 years. In otherwise healthy perimenopausal women who merely have osteopenia, the best therapeutic option is probably not bisphosphonates.
Weight-bearing exercise is essential for the prevention and treatment of osteoporosis and unfortunately, it is often overlooked and underutilized. Muscle strength is an accurate predictor of bone strength weight-bearing exercise has been shown the most effective way to strengthen bone and thus protect against osteoporosis-related fractures.
Once again, medication is not the best way to prevent osteoporosis: nutrition and exercise are key for bone health (and overall health).
On a side note, in 2008, bisphonphonates sales exceeded $3.5 billion according to data from IMS Health.
