Fosamax for Osteoporosis: Risks of Long Term Use

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Dec 21, 2006, 5:07:46 PM12/21/06

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For people with the fragile bones of osteoporosis, Fosamax and Actonel
were approved by the FDA about 11 years ago. Doctors wrote 22 million
Fosamax prescriptions last year making 3.2 Billion dollars for the drug
maker, Merck. Fosamax reduced fracture rates in the Fracture
Intervention Trial for severe forms of osteoporosis, but for the milder
form of osteoporosis (osteopenia), there was no benefit. These
bisphosphonate drugs work their magic on bones by making the osteoclast
bone cells nonfunctional. Although this allows new bone formation to
proceed normally, the removal of old bone is halted resulting in
increased bone density which shows up on DEXA bone scan.

In spite of this increased bone density, Dr. Susan Ott, Associate
Professor of Medicine, at the University of Washington in Seattle
raised questions about the long term safety of bisphosphonates in her
article in J Clin Endo Metab (Vol. 90, No. 3, 2005) . Although the
drugs appear to have short term benefits, Dr. Ott speculates that after
5 years of use, there is severe suppression of bone formation with
negative effects such as microdamage and brittleness of bone which may
cause spontaneous fractures, an outcome quite the opposite of the
intended use of Fosamax. Dr. Ott suggests stopping the drug within
five years to avoid these adverse side effects.

An example of this adverse side effect is described by Dr.
Jennifer P. Schneider in the Jan 2006 issue of Geriatrics reporting on
a 59-year old previously healthy woman on long-term Fosamax treatment.
One morning, while the woman rode a subway train in New York City, the
train jolted, and the woman shifted all her weight to one leg, felt a
bone snap, fell to the floor with a spontaneous mid-femur fracture. In
the months following, the mid-femur fracture failed to heal. Dr.
Schneider speculates that the increased bone density from the
bisphosphonate drug did not produce good bone quality. Instead she
speculates that long term use of the drug caused microdamage and
brittle bone formation resulting in the spontaneous mid femur fracture.

Dr. Clarita V. Odvina, in the 2005 issue of J Clin Endo & Metab
(Vol. 90, No. 3) reports on 9 patients who had spontanous fractures
while on Fosamax. Five of the nine cases were spontaneous mid femur
fractures with minimal trauma. Dr. Odvina raised the possibility that
long-term Fosamax (alendronate) therapy could result in increased
susceptibility to fractures, quite the opposite of its intended use.

Another bone which shows weakening from bisphosphonates is the jaw bone
which literally falls apart, a term called osteonecrosis. A recent
Library of Medicine Medline search yielded 165 articles on
osteonecrosis of the jaw associated with bisphosphonate use, and most
dentists have by now received warnings about this problem. Dr.
Dimitrakopoulos from the Department of Oral and Maxillofacial Surgery,
Aristotle University of Thessaloniki, Greece. reports in July 2006
issue of Int J Oral Maxillofac Surg. 11 patients presenting with
necrosis of the jaw, and he claims this to be a new complication of
bisphosphonate therapy. He advises physicians to reconsider the merits
of the rampant use of bisphosphonate drugs for osteoporosis.

Osteonecrosis of the jaw is also a common finding in the rare genetic
bone disease called, pycnodysostosis, which is what afflicted Toulouse
Lautrec, the famous French Impressionist artist. By the way, Toulouse
also suffered spontaneous mid femur fractures at the age of 12, just
like the woman on the subway described above. His fractures failed to
heal and Toulouse Lautrec only attained a height of 4 and a half feet.

In conclusion, the bisphosphonate drugs for osteoporosis may have some
short term benefits, however, adverse side effects of spontaneous
fracture and osteonecrosis of the jaw should be mentioned when
considering long term use. For a natural approach to osteoporosis
prevention and treatment without drugs, see my web site:
www.drdach.com. Jeffrey Dach MD