This board is for a discussion about bone health, osteoporosis and the various methods of treating this disorder.

I am 52 and have been diagnosed with osteoporsis.  I am presently taking actonel and evista.  I will have another bone density test done in 2 years to see if this treatment is working.  It seems like a long time to wait but is what my doctor advises.  Anyone else taking something different?

Hi...Molly!!I wanted to ask you if you knew how long one had to take Evista before any possitive results were expected....but it sounds like you're not sure either??!!I've heard anywhere from 6 months to 3 years.....sheesh!!   Do we have to wait that long???Although I have a physical booked with my doc next week and I plan to talk to him about it.Mom is having problems with bone loss too and will soon have a bone scan done....to see what's what!!   She asking me all sorts of questions about Evista!!  I also told her to talk to her doc about actonel....depending on the results of her scan!  Soooooooo.....I'll guess we'll just have to wait and see what happens with both her appointments and mine next week!!   *Sheesh*  Three years!!!  Man!!! I hope I heard that wrong!!!(((Hugs)))

Molly,      How do they give you a bone density test?  I'm wondering if I should have one done or should I wait?  I'm 44 years old and I have been in the perimenopause phase for about 2 1/2 years.  Advise please!       Kellie

A bone density test is very simple.  You just lie down on a table (fully clothed - but with no zippers) and a scan passes over your hips and lower spine.  Totally painless and finished in about 15 minutes!  The technician gave me my results when she finished.  I made an appointment to go back to talk with my gyn about the results. I was shocked that I had osteoporsis.  It truly is a silent disease.  I'm glad I had the test so I could begin on the medication.

Hi Snowbird:  My doctor wants me to wait for 2 years to have another bone density test.  He says that a year is just not enough time.  I FAITHFULLY take actonel and evista and have not had any side effects.  Keep me posted on what you and your mother decide.

Thanks Molly.....appreciate your response!!I just wish these wouldn't take sooooooooo...long,  I never was much for patience!! LOL!I'll let you know what happens with Mom....she's still waiting for the appointment date! *sigh*  Keep me posted too as to how you are doing....of all the things that scare me....I think osteoporosis is definitly at the top of the list.(((Hugs)))Nancy

Yes, it's silent. Same thing happened to me. I started with NP creme from Naturopath, then tried Estrogel and Prometrium b/c my doc scared me! However, that didn't go well. The rheumatologist I got sent to for the swelling I had while on the Estrogel, suggested Didrocal instead of Fosomax (b/c I have had one episode of Crohn's disease) and Actonel is new.He thought, though less efficient, it's probably less hard on the GI tract.Now, new gyn wants me to consider Evista instead and go back to the NP creme.

And, BTW, the only thing that made me FEEL better was the NP creme. And I was/am taking the hydroxypatite. But the docs keep telling me I need something more to stop/reverse the bone loss.

Anyone here ever try the Didrocal/Didronate/Etidronate..it's the original biphosphonate. Not used much anymore. It's used for 14 days out of 90. The other 76 are just for calcium. That's a plus, b/c if it causes any GI upset, it's 4x yearly, 2 weeks at a time.

Christina

Any other "young" osteoporosis patients out there? I was diagnosed (via bone density test) 3 years ago at age 45. I was tested due to a strong family history of the disease. Although I've been on Fosamax since that time, I am experiencing many perimenopausal symptoms that indicate estrogen deficiency. My Gyn says that I cannot start any type of estrogen supplement (even natural) before menopause is complete. But by that time, won't the lack of estrogen make the osteoporosis even worse? Any info on this topic would be greatly appreciated.

I had another bone density after one year and had a 3% bone density increase in the spine and 4% in the hip.  This was after I took actonel and evista for a year.  So it does work!!

Hello everyone. I am fairly new to these boards, if someone could help me I would truly appreciate. I had a bone density test and not quite sure of the results. I have an appointment next week with the Dr. to discuss treatment. Does this mean I have Osteoporosis? My T scores were not normal -2 for the hip and -1.13 for the spine. I am 38 and have been on hormones for 1 year. I had a full hysterectomy.

Hi, This is my first post on the new boards and I tried the Emoticons, but something happened.  I picked the confused one so I guess it's okay.  I am on Fosamax 75 mg.1x/ week and doing fine on it.  I was recently told by a new gyn (soon to become an x-gyn) that I needed to take less of a dosage since I was borderline osteopenic, but I think, according to the old Dr. and seeing my own results that I AM ostepenic. I will have a dexa scan in Jan. to see if it has made any difference, but from what I understand on the other posts it can much longer?  Would like to hear from anyone who has taken Fosamax.  Thanks..sharon J

Hi Sharon:

Welcome to the boards.  I have osteopenia, but from what I have heard about it (from what my gyn told me), osteopenia means 10% less bone mass than a 20 year old.  I don't know about Fosamax because I've never taken it but I agree with you that it's puzzling why your doctor said you should reduce the dosage, but maybe it's because you are "borderline" and the Fosamax is more preventive medicine than anything else.

I'm taking estrogen and was told that it can take up to 18 months to show signs of increase.  If you are taking calcium (Fosamax), there's every reason for it to increase to almost normal levels.  The problem with osteopenia and osteoporosis is when you don't treat it at all.  I'm sure you know this, but a diet rich in calcium and weight bearing excercises do help.  Check out the main page, recommendations, Ask the Experts, there's quite a bit of info there.  

By all means have another scan - I hope you get good results :smile:

The keyword to each emoticon is the word to the right, so if you want to say "shocked" - just write the word between two colons with no spaces - :keyword:   Barbie xxxxxxx

You probably have the e-mail and I think I figured it out, but still can't get the Emoticons to work!  SharonJ

Sharon:  I got your message and I replied today. I wrote from my other email address, not the Hotmail one that figures here, because I have a filter for junk mail and all new emails go there first. Hope you get it.

Kisses, Barbie xxxxxx

Hi Barbie, Just answered your e-mail and now I'm trying the boards out again.  :smile: I tried the emoticons so I will see if it works.  Forgot to mention that I am taking Biest/with natural Progesterone in one capsule twice a day, and I do take Calcium supplements as well, along with Vit. E for breast tenderness.  If I go down in the Estrogen I have too many hot flashes and if I go down in the Progesterone I don't feel as well.  That was another interesting point that the Gyn said.  She talked about Natural Progesterone not being the drug it's claimed to be and then mentioned that Progesterone is the hormone that gave us all PMS.  If that's the case then why don't I feel like PMS? I used to have that?  Perhaps someone could answer than question.  Maybe another board? Hugs, Sharon J

If your bone density test shows bone loss, can't that be improved by additional calcium in food and calcium supplementation along with weight bearing exercise?

Kaowens,  Yes to your question.  I started Fosamax last July and had a bone scan in January.  I had improvement.  I am continuing my walking weight lifting.  I think it all helps.  I am happy for the improvement.  SharonJ

Hi,This is my first time posting. I also have osteoporosis. Was diagnosed in '99 at 52. Tried fosamax in '99 but my stomach couldn't tolerate.  Now I am on the once a week actonal. These once a week medications are fairly new from what I understand. I seem to be able to tolerate fairly well. Also weight bearing exercises are very important and I'm not just talking about walking and that type of exercise. Resistance exercise is very important such as weight lifting (small weights)and working out with resistance bands. A sufficient amount of calcium is important and the best way to get it is through foods. My nutritionist told me the best things for me to eat are cooked green leafy vegetables. So I'm trying to do all these things as best I can. Will go back to the doctor in July and find out the results of the blood & urine tests I've done recently. My doctor can tell if my bones are still actively breaking down or not. If worse comes to worse my doctor says there is some type of therapy that they give intravenously and you go the hospital and receive these treatments at certain intervals but she said it was for people with very advanced osteporosis and not being able to do any of the other treatments. Hope everyone is diligent about following through with their bone scans especially if it runs in your family. And also taking their calcium, doing the exercise, and following through with meds if you need them.

Diane, Can you tell me more about the IV treatments? I have not heard of them and I know a few people who might benefit from that.  Sounds like you are doing all of the right things.  I am happy with the Fosamax so far.  No problems.  I understand there are some studies being done on how it affects the liver.  Haven't heard too much about it.  Good to hear your experience.  SharonJ  

Hi Sharon,I don't know too much about the treatments. But when I go back to the doctor in July I will ask more. I go to an endocrinologist at UConn Health Center in Farmington,CT. and they have an osteoporosis clinic and they do some studies and clinical trials. I believe it's intermittent injections of low doses of Parathyroid Hormone  and it increases the amount of bone in the spine.  There is a handbook written by the people at UConn in conjunction with the National Osteoporosis Foundation. Maybe you could find them on the web or call them and get a copy. There's a lot of info in there about different therapies, exercises and so forth. Glad to hear you're not having a problem with fosamax. I did have some stomach problems with it so now take the actonal. I seem to be able to tolerate that. I sent this message before but I don't know where it went so I apologize if I sent it twice.

Take care,

Diane

I posted on the "losing my mind" board earlier but wanted to check on this one regarding Fosamax.  Heard the bone it lays down is more brittle than regular bone.  Dr. gave me prescription but have not filled it yet.   I have osteopenia and will be going to pharmacist about naturally compounded hormone therapy.  Has anyone received postive results with progesterone like Dr. Lee indicated in his book?

Hi,  Just read your post.  I am taking Fosamax and I have heard about the bone that you mentioned, but I don't know how true it is.  I am trying to do some research on that.  On Dr. Lee, no I have not done that only that I take a bio-identical progesterone that has to be compounded along with my estrogen.  I had been on that prior to the Fosamax and I still lost bone.  With the Fosamax I improved from last year. I am not having any problems with it yet.  I am concerned about some of the things I have heard and read, but I will discuss it with a Dr. as soon as I find a good one!  SharonJ

Sharon: Thanks for the reply.  I should give it a try.  After all, some bone is better than no bone.  I have the prescription for the weekly dose.  I've been told that it doesn't upset the stomach as much.  If you find any more info on it, let me know.  I will post if I find anything also.

Thanks!Mary

Hi Mary,  I take the once a week one as well and have no problems.  At the time I had a good Dr. and he gave me prevacid (sp) so that if I did have a problem I had something to take.  I drink a whole glass of water when I take it and don't eat for 1 half hour.  I'm sure you have all of the instructions.  I will continue to try and find more info on it and will post anything I find that is interesting or could help someone.  Good Luck!  I have also have bone scans done once a year so I can keep track of it. SharonJ

Is Actonel and Evista similar to Fosamax?I'm taking Fosamax and calcium & vit D.I have osteopenia.

Hi...yes I believe Actonel and Evista are similar to Fosamax. Some people have problems with Fosamax so they use the others.  I am not sure about any studies on them so I don't know how effective they are. I can only say that my bone density has improved since I have used Fosamax.  I take also take Oscal 2 x a day. SharonJ

Not to put a damper on anything, but my bone density keeps getting worse even though I've been taking Fosamax (started with 5mg/day 2 1/2 yrs ago, then Dr. increased to 75mg/wk 1yr ago) because my T score went from -1.87 to -2.33 in 18 mos.  I said I'm not waiting another 18 mos to see if it gets worse again, so after 7 mos had another bone density & it was -2.55.  Insurance will pay for tests more often if you have a diagnosis of osteopenia or osteoporosis.  I have been taking about 1000 mg Calcium with D for the past 3 yrs & started going to the Rec Center to lift weights 1 yr ago.  I  went to an endocrinologist who did no more testing than what my regular Dr. had done & said I should take Evista (I had gone off Premarin & Cycrin 2 1/2 yrs ago).  I said I really didn't want to take Evista.  Went back to regular Dr.  Talked him into prescribing Tri-Est and Prometrium (to help me sleep at night).  Everything was fine for 6 wks when I got my period.  After a wk, pharmacy said to increase Prometrium to 2/day.  By then I was changing my tampon every 2 hrs. (I am 64 yrs old!!)  Pharmacy then suggested taking Tri-Est every other day.  Period stopped after 3 wks.  Figured I was in the clear, but this past mo., I dribbled for about 3-4 days, so will see what happens next mo. I will have another bone density in 3 mos.  I have not heard of another person in my situation.  I believe I am probably excreting calcium in my urine, but Dr. will not do a urine test or do saliva hormone testing.  What I don't understand is why Drs. do not test your hormone levels before prescribing them!!!

Singer, Read your message with interest and sorry to hear about your problems.  Just wondering about Evista?  I understand that sometimes the body just doesn't absorb Fosamax and some women switch to Evista.  I don't know anything about it, but my own Dr. did and said she had good results.  It does take a while, I believe to have results.  I also take a combination of  Bio-identical Hormones..only two of the estrogens are in it, plus progesterone. Have been on a low dose of that plus Oscal brand of calcium  with D for a while.  Let me know how you are and tell me why you don't want to try the Evista.  I am just curious since I don't know anything about it?  Take care,  SharonJ

SharonJ, thanks for replying to my post.  Haven't been reading as much on here lately, so didn't see your reply until today.  The reason I don't want to take Evista is because of all of the adverse events that occurred during clinical trials: breast pain, vaginal bleeding, flatulence (accumulation of gas), hot flashes, infection, abdominal pain, and chest pain.  And that is just the beginning.  The mfg even states that the drug has not been adequately studied in women with a prior history of breast cancer.  Evista is synthetic & is formulated in a base containing substances such as aluminum, carnauba wax, preservatives, and artificial coloring.  Also Evista induces ovarian cancer in both mice & rats & its effect on fractures is not yet known.  I got all of this info from the book, The Estrogen Alternative by Raquel Martin.  I have an appt with a nurse practitioner who is associated with a gynecologist on Monday.  I just have lost faith in my family Dr.  My daughter has a gynec & doesn't even have a family doctor, so thought, why not give it a try.  Maybe I can talk her into doing the urine test or saliva test so I don't have to order it myself. Are you having good results with your natural hormones?  Do you feel good?  I think that is very important, as I was not feeling good for the past 2 yrs.  Have aches & pains in my legs & could not get to sleep many nights.  That has improved some since being back on the hormones.  Thanks for caring.  Singer

Hi Singer,  Gosh, I am shocked at all the side effects of Evista!  What about the other one? Begins with an A?

I sure know what you mean about "losing faith" in the Dr. situation.  I have lost it all...but I keep trying different ones until I get the one I like.  I have pretty good insurance now so that will help. As for the bio-identical hormones...they have been great....no real side effects. I was on the synthetics before and had a really bad time and felt terrible.  I did a lot of reading and talking to a lot of people and decided  to give it a try.  What a difference!  I felt like myself again.  I am still taking them at a low dose, but they still work.  Maybe something you can look into.  I know there is another board to discuss this on as I have posted there. If you are  interested it's under "bio-identical" I believe, plus there is a lot of information on them thru some of the transcripts that are available on the site.  Keep me posted with your progress and don't give up!  There is help available and help you can trust!  SharonJ

To Singer,  Sorry I gave you the wrong info on the boards for bio-identical hormones.  It is under Naturally compounded hormones.  Also wanted to add that I take magnesium along with my calcium!  SharonJ

Hello

I know that women over 50 and perimenopausal should be taking something to help prevent osteoporosis, but I don't know what.  Are over-the-counter calcium tablets good----and if so what dosage?  I have spent so many years worrying about my kids and their well being that I don't know the first thing about taking care of myself.  I decided that I had better start now while I am still young enough to prevent anything bad from happening to my bones.  I would appreciate any advice.  Thank you.

Not sure about the advice as there is always something new to deal with.  I take calcium (Oscal) and magnisum over the counter,plus I take a weekly dose of Fossamax.  Plus I take bio-identical hormones and so far I have been maintaining.  Hope this helps.  Lots of info on this site so I am sure you can lots of it!  SharonJ

dcamp, Dearest recently had Dr. Felicia Cosman as a guest in a Power Surge chat.  Dr. Cosman is an osteoporosis specialist, the Clinical Director of the National Osteoporosis Foundation, Medical Director of the Clinical Research Center at Helen Hayes Hospital in West Haverstraw, N.Y., and associate professor of clinical medicine at Columbia University.

She also wrote a book called "What Your Doctor May Not Tell You About Osteoporosis: Help Prevent--and Even Reverse--the Disease That Burdens Millions of Women".

You can read the transcript of this chat here: http://www.power-surge.com/transcripts/cosman.htm.  I'm sure that there are answers there and in her book.  You can just click on the name of the book above to see more about it.

I've taken calcium carbonate supplements for<br>decades. &nbsp;I had a bone scan a couple years<br>ago, due to being at high risk for osteoporosis,<br>because of hyperthyroidism. &nbsp;I was fine. &nbsp;<br>Weight bearing exercise is also an excellent<br>preventative. &nbsp;That I must resume again.<br>Bone health begins in the teen years. <br>Adequate calcium intake in teen girls<br>is crucial. &nbsp;Consuming soda with<br>phosphoric acid is particularly bad, as<br>is smoking and heavy alcohol consumption.

To SharonJ: Had 2 bone densities about a month ago--they are changing over from QCT to DEXA, so had both so they could be compared. My T-score was -2.54, previous one was -2.55, so am very happy about that. The nurse practitioner I went to had me do a bunch of labs & found out I have hypothyroidism, so now I am taking Levoxyl for that-have to be careful when I take my calcium (4 hrs after Levoxyl). This nurse practitioner went to a symposium on natural hormones in Chicago & is ready to prescribe them. She was advised by the Dr. that was the presenter to change from Tri-Est to Bi-Est, so that's what I am on now. I would like to quit taking Prometrium & use progesterone cream instead, so that is my next step. Sorry I took so long to post, but have been busy researching thyroid.

Hello Everyone: I was just diagnosed with osteoporosis at the age of 48. I am in a high-risk group to begin with--petite, small-boned, correct weight for body size and frame, caucasian and no kids. What upsets me the most is that I have been physically active all my life, quit smoking at age 23, stopped drinking all sodas in 1980, vegetarian for several years, spent many years in the sun, etc. I have been on oral steroids briefly for asthma and for inhaled steroid for many years. I have bad gastrointenstinal illness (IBS, GERD, my digestive system is 75% paralyzed) so Fosmomax is not recommended. My gyn refuses to help me in any way unless I go on synthetic hormones (won't even discuss natural menopause options with me) I am in a high risk group for hormones anyway due to breast cancer concerns and history of cancer in family. I skip periods for months, and then get one that is a mess and then don't get one for months, which is fine with me. I live in a bad area for women's health (the DEEEEEEPPPP South) unless you want to get pregnant, so finding a gyn who will actually spend more than 5 minutes with me seems impossible, and I have had three over the past three years. Nobody is interested. Can anyone tell me how to proceed in helping myself? I am at a loss of what to do next...I am a Yoga teacher, so I do stay active. Any help would be greatly appreciated. Sincerely, Queen of Swords

Hi everyone, this is my second post today so sorry to be such a bore. I had a bone scan last October and the results came back as normal. Bearing in mind that was some months ago it doesn't necessarily mean that all is well anymore because I went into full menopause very recently. I'd like to take supplements for the bones but there seem to be so many out there and probably the ones any of you take I might not be able to get in the UK. Two weeks ago I ordered some tablets online. I got an email response which was: Dear Mrs Patricia M Shoesmith, Thank you for shopping at Coral Calcium Online . We have received and are processing the following order: ****************************************************** Order Number: MM07LF10000121 Order Date: 12/5/2004 12:47 I've tried replying to this email to ask when my order will arrive but have had nothing back yet. Has anyone had any experience of Coral Calcium Online, or is it just another big sick con playing on desperate people willing to go to any lengths to safeguard their health? Look forward to your responses.mad: Trish:

HI

How to protect yourself from osteoporosis
I read this in the Guardian newspaper in the UK the other week and have just pararphrased it from the online Guardian - sage advice - although I havent taken up rowing or skipping yet!!! You can find it on the Guardian website - put in osteoporosis into the search engine

GET OUTSIDE
Along with calcium, vitamin D is crucial for bone development. Sunlight is by far the best source. Exposing your face and arms for 30 minutes a day between April and October (remember this is written in UK!!!) - is enough to ensure levels remain stable. That isn't an excuse to roast in the sun, though.
START SKIPPING
Weight-bearing exercise is essential for building bones - just 15 skips a day can make a significant difference. Taking stairs instead of a lift also helps: running upstairs provides on average 20 beneficial, high-impact jolts to the spine and hips; repeated five times a day, and the 100 jolts will protect your skeleton.
DON'T UNDEREAT OR OVEREXERCISE
Dancers, gymnasts, long-distance runners and people with anorexia or bulimia nervosa are all known to be at greater risk of osteoporosis than the general population. Because their low body fat levels and often inadequate nutrient intake leaves them vulnerable to weak bones. The same goes for yo-yo dieters and excessive exercisers.
MODERATE CAFFEINE
Some researchers have linked a high caffeine consumption (more than six cups of coffee a day) with the leeching of calcium from bones. People who drink cola and other caffeinated carbonated drinks tend to excrete calcium through their urine. But tea drinkers have stronger bones than non-tea drinkers - flavonoids (plant chemicals that act as antioxidants) in tea that were probably responsible for promoting bone density. Tea also contains fluoride, an important mineral for bone development. Women who added milk to their tea had much higher bone mineral density in the hip area.
AVOID FIZZY DRINKS
Drinking large amounts of fizzy drinks may weaken your bones. Carbon dioxide in drinks increases acidity. As this acid enters the bloodstream, the body attempts to neutralise it with calcium, the alkaline bone-building mineral. Also the phosphorous content of the drinks alters the balance of minerals in the body and causes calcium to be broken down.
ROWING
Although it is not strictly weight-bearing exercise, studies have shown that the resistance of rowing against water (indoor machine has same effect) significantly improves bone density in the spine. Other sports to try include running (hips) and weight training (wrists, hip and spine).
BONE-BUILDING DIET
Milk and dairy foods are the obvious sources of calcium (pint of skimmed milk every day). Try eating more oily fish and eggs (rich sources of vitamin D), dark green leafy vegetables and tinned fish (such as salmon). Foods to limit include those containing oxalic acid (almonds, rhubarb and chocolate) and phytic acid (wheat bran, brown rice and nuts), both of which inhibit calcium absorption. Excessive intakes of salt and alcohol are bad news, as is smoking. A supplement of vitamin D and calcium can be beneficial.

Mele

Wow Mele, that was a plethora of information you took the time to write. I learned a few good things, thanks Tinkybug

Yes, Mele, thank you. There were many things in there I wasn't aware of.

Osteoporosis Meds such as Fosomax, Actonel and Boniva are in the Bisphophonate Class. Reasearching these drugs is reccommended as they can cause some people debilitating pain. To read about specific drug reviews go to www.askapatient.com and type in the name of the drug. I have had adverse reactions to Evista and Boniva.

Pat


Bisphosphonate Fact Sheet


• The action of bisphosphonates is not fully understood, and their long term effects are unknown. What is known is that they effectively poison and kill bone remodelling cells. One hundred and fifty years ago they were used for making soap and de-scaling boilers. In humans they permanently adhere to the surface of bone, particularly on sites where there is active bone turnover. The cells that reabsorb old or damaged bone (osteoclasts) quite literally swallow a dose of the drug when resorbing the bone. Once inside the osteoclast cell the bisphosphonate poisons a key enzyme which switches off the cell’s ability to function and causes it to die. For a time the cells that rebuild bone (osteoblasts) will continue to function – hence the increase in bone density observed with the use of the drugs - but they eventually die as well, as they require the action of osteoclast cells to stimulate their action. Thus although bisphosphonates may favourably influence bone density loss, there are concerns that because their mechanism of action suppresses the bone remodelling process long term use may result in brittle bones that are prone to fracture.

• New evidence links the bisphosphonates with increased micro-fracture, osteonecrosis (bone death) of the jaw, and spontaneous fractures displaying delayed healing. i ii

• Bisphosphonates have an indefinite half-life of at least 10 years duration so the effect of the drug continues for better or worse once stopped. The amount of drug within the bone will accumulate with use thus continuing its effect for better or worse. There is no known method of removing the medication from the bones. iii

• Bisphosphonates can have very unpleasant side-effects. The gastro-intestinal side-effects have been well documented. A lesser known side-effect is now evident. Hundreds of women using Fosamax and Actonel report on patient websites that they are experiencing chronic, often severe, joint and bone pain, swelling of ankles and feet, muscles cramping and stiffness, and difficulty walking. A 2005 Serious Adverse Events report from the U.S. Food and Drug Administration describes Fosamax-related bone joint and muscle pain as ‘severe,’ ‘extreme,’ ‘disabling,’ or ‘incapacitating.’ “Many patients were unable to walk, climb stairs, or perform usual activities. Some became bedridden, and others required walkers, crutches, or wheelchairs.” They caution that “underreporting of pain is probably considerable because of its subjective nature and because physicians may attribute pain to osteoporosis.” iv

• The anti-fracture benefit from bisphosphonates is minimal. Studies have found vertebral fracture benefit with Fosmax, Actonel and Boniva where bone density is very low and there has been a previous vertebral fracture, but even then the drug will not benefit the majority in this category who take it. For example, 22 older women in this category would need to take Fosamax for three years to prevent one vertebral fracture discernible by X-ray in one of them. v Read more...

• Most vertebral fractures are asymptomatic. Hip wrist and rib fractures are more serious, more painful, and more incapacitating than vertebral fractures. A recent review of the intention to treat data for a range of osteoporosis treatments from 11 randomised clinical trials of at least 3 years duration failed to find any non-vertebral fracture benefit at all from alendronate. v

• Bisphosphonates should not be used by younger women of child-bearing years. Dr Susan Ott, Associate Professor of Medicine at the University of Washington warns: “Studies in animals show fetal and maternal abnormalities in bones and calcium metabolism, so it is unethical to study this medication in pregnant women or women who might become pregnant while the bisphosphonate is still in the bones.” vi

The Bisphosphonate Family:

Etidronate (Didronel) and clodronate (Bonefos) were the first bisphosphonates. Neither drug is approved in the US for the treatment of osteoporosis. Etidronate is approved for subsidy in New Zealand.


Alendronate (Fosamax) and risedronate (Actonel) are two second-generation nitrogen-containing bisphosphonates that have been shown in randomized trials to increase bone mineral density in postmenopausal women. Their anti-fracture benefit is minimal (see above) and limited to those with previous vertebral fracture and very low bone density (i.e. established osteoporosis). Even then it will not benefit the majority who take it. Alendronate or risedronate once weekly has been shown to reduce the rate of gastro-intestinal side-effects.


Ibandronate (Boniva) was approved by the Food and Drug Administration (FDA) in 2005 for both the prevention and treatment of postmenopausal osteoporosis at a dose of 2.5 mg daily or 150 mg monthly, Daily ibandronate has not been shown to be effective in preventing non-vertebral (i.e.hip etc.) fracture and only minimally reduces the incidence of vertebral fractures in people with previous vertebral fractures.

Pamidronate (Aredia) is intravenous. Is used to treat women who cannot tolerate oral bisphosphonates; but its efficacy in reducing fracture has not been established. Acute and delayed hypersensitivity reactions can occur with intravenous pamidronate, and its use is contraindicated in patients with vitamin D deficiency, since the drug can cause a precipitous drop in serum calcium levels

Intravenous zoledronate or zoledronic acid (Zometa), is FDA approved for the treatment of malignant hypercalcemia, multiple myeloma, and skeletal metastases. Research is being conducted in New Zealand on its role in the treatment of Paget’s disease. It is very potent as it can suppress bone resorption and increase bone mineral density in postmenopausal women for as long as one year from a single 4-mg dose. As yet there is no data to evaluate the safety and efficacy of this drug in reducing osteoporotic fracture. The FDA advised dentists and cancer physicians in May 2005 that the labels or package inserts for the injectable bisphosphonate drugs zoledronic acid (Zometa) and pamidronate (Aredia) had been revised to warn about the possibility of osteonecrosis (bone death) of the jaw. viii



References:

i Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL. Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg. 2004 May;62(5):527-34.


ii Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, Pak CY. Severely suppressed bone turnover: a potential complication of alendronate therapy.
J Clin Endocrinol Metab. 2005 Mar;90(3):1294-301.


iii Ott Susan MD “Osteoporosis and Bone Physiology”.
http://courses.washington.edu/bonephys/ opop/opdem.html


iv Wysowski DK, Chang JT. Alendronate and risedronate: reports of severe bone, joint, and muscle pain. Arch Intern Med. 2005 Feb 14;165(3):346-7.

vBlack, D.M., Cummings, S.R.et al. ‘Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures.’ Lancet 1996;348:1535-41


vi Boonen,S., Laan, RF., Barton I P., Watts, NB. Effect of osteoporosis treatments on risk of non-vertebral fractures: review and meta-analysis of intention-to-treat studies Osteoporosis International Published online: 29 June 2005

vii Ott, Susan MD. ibid

viii http://www.fda.gov/medwatch/SAFETY/2005/zo...tite_5-5-05.pdf