This was posted today at the Peoples Pharmacy:

Don't Count on Bone Drugs Long Term

FDA researchers are questioning the long-term benefits of bone drugs like Actonel, Boniva, Reclast and Fosamax (alendronate). These bisphosphonate medications are prescribed to build bone and reduce the risk of fractures. According to the FDA, "more than 150 million prescriptions were dispensed to outpatients between 2005 and 2009."

It's hardly any wonder the drugs have become so popular. Anyone who watches television is likely to have seen Sally Field speak convincingly about the benefits of Boniva and how it can help stop and reverse bone loss. Reclast commercials are equally convincing. The actors look so healthy and happy it is hardly any wonder that people contact their doctors to get a prescription.

So, how good are these drugs really, especially when it comes to long-term use? The study, published in the New England Journal of Medicine (May 9, 2012), suggests that after the first three to five years, these drugs offer little, if any, reduced risk of fractures. And reducing fractures is the whole point of the exercise. Just improving a score on a bone mineral density test is not enough to warrant long-term use.

The FDA analysis also pointed out that these drugs may have some disconcerting rare risks: Atypical femur fractures [thigh bone breaks], osteonecrosis of the jaw [jaw bone death] and esophageal cancer.

Other possible side effects of this class of medications include:

• Joint pain and stiffness
• Back pain
• Digestive distress, nausea, heartburn and esophageal irritation, constipation, gas
• Flu-like symptoms
• Dizziness
• Fatigue
• Muscle aches and cramps
• Insomnia

The FDA was very cautious about offering recommendations directly to prescribers or patients. The researchers did say that "patients at low risk for fracture (e.g., younger patients without a fracture history and with a bone mineral density approaching normal) may prove to be good candidates for discontinuation of bisphosphonate therapy after 3 to 5 years..."

Bottom line, there is a lot of uncertainty about the long-term benefits of these widely-prescribed bone drugs. The FDA calls for...guess what..."further investigation...for determining the best regimen of treatment for individual patients with osteoporosis." Thanks a lot FDA for these words of wisdom. Is it likely that drug companies are going to spend the money to do this kind of long-term study? Probably not, given the rather bleak report card from the long-term studies that have already been completed.

http://www.peoplespharmacy.com/2012/05/10/dont-count-on-bone-drugs-long-ter m/

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There ya go - truth will out, eventually... As for the FDA 3 - 5 years, NICE (UK) recommendations are for NO longer than three years, anyways.

Strontium Citrate, supplements and vitamins are the way to go - I reversed my own osteopenia using just that methodology.

Yet more of the same - piling out of the woodwork -

Bone-strengthening drugs such as Merck & Co. (MRK) (MRK)’s Fosamax, used to treat and prevent osteoporosis in older women, may have little long-term benefit, U.S. regulators said in an analysis of previously released studies.
http://www.businessweek.com/news/2012-05-10/bone-drugs-may-not-help-women-l ong-term-fda-review-says

And -

The response from the American Society for Bone and Mineral Research:
http://www.asbmr.org/About/PressReleases/Detail.aspx?cid=1a85abd7-c04d-44ba -a2b5-c1a05485a63d

Researchers Take Another look at Bisphosphonate-Cancer Link
http://www.emaxhealth.com/1506/researchers-take-another-look-bisphosphonate-cancer-link

New FDA Study on Bisphosphonate Drugs
http://www.fda.gov/drugs/drugsafety/ucm229009.htm



More such reports are appearing.

Hey Molly dear!

Starting to read up on this topic a little too, but seem to be developing a slight allergic reaction to too many links, lol

Have you been running into much discussion about the effects of exercise on preventing bone loss? Tricky for people who are in pain of course. But remember some studies that connected low-gravity situations such as astronauts in space where they developed bone loss, something to do with weight-supporting bones and how they do less work when there is less gravity....hmm...maybe this will ultimately be proven to be even more of a factor than previously suspected?

Hello Dow - Long time no see! Missed you, and the four footed ones. How's you then?

Yes, lots of links - and more people showing up with side effects to the Bis drugs - scary.

Yes. Lots of discussions as to weight bearing exercises and exercise generally, including the facts of the astronauts and how weightlessness does indeed lead to bone thinning. Exercise comes high on the agenda for treating osteo, but for some that is difficult...

If one has a DDx of osteo, then one needs to have an exercise programme of some description, then take the supplements, vitamins, minerals various, and Strontium Citrate and, look to diet as well. Between that lot, one can reverse osteoporosis. As may be seen on the National Osteoporosis Foundation, 'Team INSPIRE' site. Enlightening broad based discussions (and some 'still' taking the Bis drugs, whilst 'many' others who have taken have developed horrible side effects) but excellent information and recommendations over there (and good to find others digging up info!) It is a huge site, need a GPS to navigate - I keep getting lost!

Anyways. There ya go. Take care - great seeing you. Go well -

So if you don't have a fracture history and are at low risk for fracture with a close to normal bone mineral density.... then why the h*ll would you have been given biphosphonates anyway????

Something that struck me ages ago when I first looked at the whole osteoporosis thing was that actually bone density seems to have very little correlation to fracture risk anyway - fractures are more about falling badly, than just falling, and if you retain as much flexibility and fitness as you can, along with core stability, then you aren't going to be anywhere near as likely to injure yourself. Thats one reason why "falls prevention programmes" have been taken on board by a lot of folk.

I think there are a lot of different issues around low bone density, but the quick fix is to prescribe bis drugs, when maybe they aren't at all appropriate for most people.

cemc - Think that is a sop towards the pharma Cos! In effect the FDA are saying 'steer clear' of the Bis drugs... Which is a sane admonishment, but, they can't be 'seen' to really be saying that, as they have endorsed these Bis drugs for many years, and, are still doing so with the new ones coming on line. The FDA has very few teeth and what they have got, they seem to use more for tearing and ripping apart alternatives, supplements and herbals...again, fear of pharma and the big agri Cos (and we won't talk about Monsanto!!) Sad state of affairs.

Yep. There is NO need to ever take those Bis drugs - better alternatives exist outside that drug scene.

Yes - Falls and fractures. Evidence and thinking in that direction is beginning to come through. Retain flexibility and fitness, also, bone density is not necessarily a mark for bone strength! That was postulated a few years ago, but not much followed up on, excepting in a few random papers (more is in evidence in/about pushing those bis drugs - more's the pity). But that's the 'bottom line' at work - the 'art' of accountancy with NO accountability! (Totally blinkered, one directional line approach!) Poor us the patients - so, be proactive. Have to be. Blasted tedious.

I'm still trying to find info on that "Strontium vs bis- drugs trial" and haven't had any luck. My doc is amused that I'm trying strontium citrate, but isn't actively upset about it. DXA last month doesn't show any better after a year of strontium, but it's not any worse. Between numbers for lumbar spine and each femoral shaft, it averages out to about the same.

I spent about a year total on a bis- drug--9 months on Fosamax and 2 on Atelvia. Hubby is on Atelvia now. He didn't want to take strontium. We'll see on his next test if it's helping any. He started it just under a year ago when the prostate cancer was diagnosed and he had to give up his testosterone replacement to treat (along with Cyberknife radiation therapy).

So if you find anything about THAT trial, I'd be interested. And I would share it with an osteoporosis newsgroup, who think I'm nuts for using strontium, save for one other person. LOL. Molly, you are such a radical. Too funny.

OK - Thought I'd posted it. Not much information. Just interleaved in between the Bis drugs. Said to give the Stront C. to post menopausal women. Otherwise use the Bis drugs. Said that all the drugs took a time to show reversal. Stront C takes a bit longer than the Bis drugs, but, no side effects as such to report. Though the Protelos Strontium Ranelate came in for a bit of a pasting - but the Protelos stuff aint S. Citrate. Protelos is chemicalised S.C. then buffered with Aspartame, Maltodextrin and Mannitol. There are side effects to the Protelos.

A load of information on the INTENSE osteoporosis group. Can't access the info I want as on other computer and this PC is near enough to knackered.

Suggest that you check out at INTENSE, osteoporosis Foundation. Very good information and, get that book, Your Bones by Lara thingie and Dr Wright - sorry but everything on laptop that does nowt but crash on me today and this big ole PC is a shi..y so-an-so, can't see the screen properly - it throws dble imaging and the sight in me R. eye is crap again an this keyboard is different...

What a stupid day it was today.