About Bisphosphonates - When to Stop Them


Medical treatments are continually studied and recommendations to medical professionals are regularly revised. In this post I will update you on the latest recommendations related to the drugs used to treat osteoporosis and osteopenia (pre-osteoporosis). Click here if you would like to review an my post about the risk factors, detection and prevention of these conditions.

If you take Fosamax, Atelvia, Actonel, Boniva or Reclast (or if your health professional has recommended you take one of them) read this post to learn how get the most benefit from them.

What Do These Drugs Do?

Bone is living tissue and it is constantly breaking down and rebuilding itself (this is referred to as “bone turnover or remodeling“). In some women after menopause (and under certain conditions in some men), bone breaks down more quickly than it builds up. Gradually the bones become fragile, weak and prone to fractures.

Fosamax, Actonel, Boniva and Reclast all come from the same class of drugs (called bisphosphonates). What bisphosphonates do is slow the breakdown of bone. They do this by inhibiting the cells that breakdown bone (called osteoclasts). For a year or so after starting the any of these drugs the bones actually become stronger because there is still bone turnover going on. And because the osteoclasts are being inhibited, bone builds up faster than it breaks down.

Over time, though, these drugs supress bone turnover and remodeling so bone metabolism becomes static. While the medications stop the osteoclasts from breaking down more bone, formation of new bone is also stopped. In the first 5 years on these drugs bone strength increases and risk of fracture decreases – that’s a good thing and is what the medication is prescribed to do.

What Are the Long Term Effects of These Medications?

It is not known what the long term effects of these medications are beyond 5 to 7 years. There is concern that after 5 to 7 years there may be increased risk for other types of fractures, particularly in long bones (as opposed to spine and hip where most osteoporosis fractures occur). It is believed this may be because the drugs prevent bones from remodeling and repairing small injuries. Jennifer P. Schneider, M.D. posted an interesting case study illustrating this concern, you can click here to read it.

What About the Jaw Problems I Have Heard About?

That’s a condition called osteonecrosis of the jaw (meaning death of the jaw bone) and it is an awful thing. In 22 years I have only seen one case of it. It is very rare and is usually only seen in people receiving bisphosphonate drugs as part of cancer chemotherapy at much, much higher doses than those that are given for osteoporosis. One source I found estimates its risk at osteoporosis treatment doses is about 1 in 60,000. Click here to view that source and read more about osteonecrosis of the jaw. Other sources I read put the risk at 1 in 100,000. It is very rare.

What is the Take Home Message?

  • If you have been on bisphosphonate medication for 5 years or more schedule an appointment to discuss your treatment plan with a health professional.
  • Do not be afraid of medications that treat osteoporosis and osteopenia.
  • You will live with your condition for many years and there are no hard and fast rules about when and how long to treat. The best plan is the one that is tailored specifically for you.
  • There are a variety of strategies that can be put to use to protect your bones, prevent fractures and make the best use of the medications available.
  • Read my other post on osteoporosis and osteopenia to learn the lifestyle behaviors and vitamins you can take to slow or prevent the progression of the disease.
  • Finally, do NOT fall!!!

If you want to learn more you can find more detailed information at this link. It’s an academic site maintained by Susan Ott, MD, Associate Professor, Department of Medicine at the University of Washington about bisphosphonates.

This information is offered for educational purposes only and is not intended to diagnose, prescribe or treat. For that please seek direct care from a health professional.

Permalink  ·  

#1 | On December 06, 2010, vi waidley said:

I am on actonel..bone have improved
I am know osteopenia..just not sure if I need calcuim

#2 | On December 06, 2010, Carla said:

Recommended calcium intake for women is 1500 mg/day which is best acquired through foods high in calcium.

Example: three 8 ounce servings of dairy - 8 oz. skim milk or low fat yogurt - per day.

If you are lactose intolerant discuss taking calcium supplements with your health care provider - 1500 mg/day. And don’t forget to include vitamin D with the calcium. It is also necessary to maintain strong bones.

Carla Mills

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