New warning for patients who use Fosamax to protect bones
Sinking Fast
If you were thinking about purchasing an 882-foot ocean liner, you would probably want one that wouldn’t sink if it hit an iceberg. So if an ocean liner salesman told you he had just the thing - guaranteed unsinkable - except for one small caveat that it might sink if it hits an iceberg, you would probably tell him, “I’ll get back to you later.”
Later - as in “never.”
A patient who’s considering the use of Fosamax (the medication that prevents bone loss) might get the same sort of “get back to you later” feeling if she happens to come across a recent study in the New England Journal of Medicine that offers yet another reason to avoid this medication like a leaky ocean liner.
Giving bones a break
The Fosamax web site advises patients who use this drug to stay fully upright for at least 30 minutes after swallowing a dose. This is necessary to help the pill reach the stomach quickly, otherwise the dose may irritate or even ulcerate the esophagus, prompting heartburn and possible chest pain.
But once Fosamax gets to the stomach and enters the blood stream, some users may wish they’d never swallowed it at all.
This past January, the FDA sent an alert to physicians stating that biophosphonates like Fosamax may cause severe bone pain. But the Fosamax web site takes that warning even further, telling patients who use the drug to contact their doctor in the event of “severe bone, joint, and/or muscle pain.”
Biophosphonates increase bone density by tinkering with a remarkable process that keeps bones strong and healthy. We tend to think of bones as static structures, hard as rock, but in fact our bones are alive with a constant turnover of osteoblast cells (which increase bone density) and osteoclast cells (which remove bone). When biophosphonates intrude on this process - boosting osteoblasts by removing osteoclasts - the complex natural balance is put at risk.
How much risk? According to Dr. Joseph Lane of Cornell Medical College, this drug that’s supposed to protect bones may actually increase fracture risk.
Time for a holiday
Based on previous research that shows a potential link between prolonged biophosphonate use and increased risk of thighbone fracture, the Cornell team examined a group of fifteen women who had used Fosamax for an average of about five years. Each of the subjects had also experienced a thighbone fracture. Dr. Lane’s analysis showed that ten subjects had a similar, very specific type of fracture. Among these ten, Fosamax had been used for an average of more than seven years.
Dr. Lane explains to HealthDay News that slower bone turnover caused by biophosphonate use may prompt a gradual microdamage in the thighbone. Over time this damage slowly takes its toll, making some patients susceptible to fracture when they experience a fall - even a very light fall from a standing position.
And then Dr. Lane tells HealthDay exactly what we’ve come to expect in studies that put a popular medication in a very poor light: Patients who take Fosamax should keep taking it. And he adds: “This is a great drug that does wonderful things.”
Right. Please ignore the heartburn, bone pain, and broken legs. (The HealthDay article also notes that Fosamax was recently linked to increased risk of irregular heartbeat.)
But after Dr. Lane completes his genuflection to this wonderful drug, he makes a suggestion that reveals something closer to reality: He tells HealthDay that women who use Fosamax for a long period and have low bone turnover might want to talk to their doctor about taking a “bone holiday,” and discontinue use for a year.
A bone holiday! Sounds nice. And while your bones are enjoying the relief of a drug-free holiday, that might be a perfect time for a nutrition makeover. In the e-Alert “Rags to Riches” (1/25/07), you’ll find several suggestions from Jonathan V. Wright, M.D., and HSI Panelist Allan Spreen, M.D., about the key nutrients necessary for optimal bone health, at this link: http://www.hsibaltimore.com/ealerts/ea200701/ea20070125a.html
Sources:
“Atypical Fractures of the Femoral Diaphysis in Postmenopausal Women Taking Alendronate” The New England Journal of Medicine, Vol. 358, No. 12, 3/20/08
“Fosamax Linked to Unusual Femur Fractures” HealthDay News, 3/19/08, nlm.nih.gov
http://hsibaltimore.com/2008/04/07/new-warning-for-patients-who-use-fosamax-to-protect-bones/
