Sticks and Stones May Break Your Bones…and So Might Osteoporosis Medication?

by Ashley Alexander on February 23, 2012

Yes, you read that right.  Odd as it sounds, new studies are suggesting that long-term use of bisphosphonates, a group of drugs commonly taken to treat osteoporosis, may be causing unusual bone fractures.  Huh?

X-ray image of pelvis and femurs. Source: Wikimedia Commons. Used under CC license.

Let’s back up a little.  A few weeks ago, I wrote about a recent study that found high-impact exercise to have bone strengthening benefits.  The positive results of the study were found using a sample of 25 year-old women, the majority of who opted for jogging and spinning as their preferred type of exercise, prompting several comments about alternatives for older women and those who cannot take part in high-impact exercise due to injuries.  I knew that high-impact exercise was only one strategy for improving bone density and preventing osteoporosis, so I set out to find more information.  As I expected, there are indeed other options for promoting bone strength.  But as it turns out, there’s a lot more to the story.

As mentioned in my previous post, osteoporosis is a disease characterized by thin, fragile bones which result from the body’s resorption of calcium as we age, and is particularly common among women.  This is a health concern largely because thin and fragile bones are much more susceptible to fractures, and fractures that occur in older adults are more likely to result in complications and death.  Taking action to build bone strength before resorption occurs helps prevent bones from becoming brittle and breaking.  Beyond high-impact exercise, consuming the recommended amounts of calcium and vitamin D can also help strengthen bones in younger women and keep them strong for those who have already reached their peak bone density.

However, for many older women, calcium and vitamin D alone are not enough to protect their bones against fractures.  That’s where bisphosphonates come into play.  Widely marketed and prescribed for osteoporosis treatment, some bisphosphonate brand names—Boniva, Actonel, Fosamax—probably sound familiar.  These drugs help protect against bone thinning by slowing the resorption of calcium, and have been known to prevent hip fractures, the most common and severe fracture among older women.  That’s good, right?

Well, maybe not.  According to a 2011 study published in The Journal of the American Medical Association (JAMA), older women who take bisphosphonate medications for an extended period of time (5 years or longer in the study) may be at risk for an uncommon type of fracture in the shaft of the femur, the long bone in the thigh.  Because the hip is a joint, most hip fractures do involve the femur—but at the bone’s head (or the ball that fits into the socket of the pelvis), not in places along its length.  So while these drugs can prevent one type of fracture, they might be responsible for another.

Even though that may sound like cause for alarm, it might be too early to worry just yet.  The researchers in the JAMA study noted that although there was a significantly increased occurrence of femoral fractures for the women who took bisphosphonates for five years or more, the overall risk was still very low.  The reassuring news is that there are more studies in the works that look at how bisphosphonates may affect fractures, and the FDA and other authorities are monitoring the situation, too.

For the best protection against osteoporosis-related fractures, it’s important to look beyond prevention and consider how medications for treating bone loss, and possibly those used for other conditions, may impact our bones as well.  Obviously, when deciding to begin a drug regimen—or deciding if one should be stopped—it’s important to consider the pros and cons, and it’s always a good idea to discuss them with your doctor before making a final decision.

As for me, I think I’m going to start incorporating more high-impact exercise, calcium, and vitamin D in my life while I’m still reaching toward my peak bone density…just to be on the safe side.

David Bradley February 24, 2012 at 5:59 am

Quite timely as I had a bone density determination (done using DXA) just yesterday as part of a general health study in this part of the world. I don’t think they found osteoporosis, but I know several people who have the condition and my wife a fair expert in physiology/anatomy and such is forever diagnosing people in the street based on posture and gait. It’s a big worry. Osteoporosis kills a lot of people indirectly. They end up in hospital and never go home. It’s worrying to hear that there may be a risk associated with the medication for this condition. All the more reason for youngsters to get plenty of calcium and to avoid the common risk factors like smoking tobacco.

Ashley Alexander February 26, 2012 at 6:00 pm

Thanks for reading, David! From the research I’ve done, I completely agree that osteoporosis is a serious health issue–one that maybe doesn’t receive enough preventative attention for the younger population though it’s so important.

Kristy E. February 24, 2012 at 11:29 am

Once again, I love your title. You have a gift for creating titles that draw people in and make them want to read your posts. From a writing standpoint, I think you did an excellent job with this one. You created a short, to-the-point introduction, but still kept it interesting. You did a great job providing many layers of information around the osteoporosis subject and explained it all in terms that made it clear for those of us without a science background to understand. Finally, I loved the way you inserted a bit of your personal opinion at the end to create a cute (but again short and to-the-point) ending. I really enjoyed reading this one. Great job, Ashley!

Ashley Alexander February 26, 2012 at 6:02 pm

Thanks for your kind comments, Kristy!

MB Lewis February 24, 2012 at 2:44 pm

Ashley: Like this post very much, and your warm writing style. Is it just [dummy] me, or am I missing something that would help me understand why certain medications could create risk for ONLY one kind of bone fracture? Does physics about the bone size or shape explain this? Just wondering…

Ashley Alexander February 26, 2012 at 6:05 pm

MB, that’s a very good question. I think the physics of the bone structure seems like a reasonable explanation, but I’m not sure. From what I read in the study I included in my post and other articles on this topic, it doesn’t seem like the researchers are quite sure why this particular type of fracture occurs either. As it continues to be studied, maybe they will gain more insight. Thanks for reading!

Catherine OGawa February 24, 2012 at 6:45 pm

Good and timely article. Bisphosphonates have been effective in preventing fractures and mortality. The side-effects of bisphonates are rare, but development of jaw necrosis and atypical fractures are frightening and not fully understood. Recently an FDA advisory panel recommended labelling changes to specify the advisable duration of treatment and possibly limiting use to 3-5 years. You are right that proper diet, calcium and vitamin D (supplementation being safer than unprotected sun exposure), and exercise started young are preventative. However overdose of vitamin D can also be risky so best to check the blood levels.

Ashley Alexander February 26, 2012 at 6:23 pm

Thanks for commenting, Catherine. I read about the possibility that there may be restrictions on the duration of bisphosphonate use and also that taking a “holiday” during use may help to limit the risks, too. Thanks for pointing out that it can be dangerous to overdo it on vitamin D, whether it be by supplementation overdoes or from complications resulting from excessive sun exposure.

Michelle Mathas February 25, 2012 at 12:52 am

Hi Ashley. What a great article. Comprehensive, informative, yet still a bit funny and personal. You thought of all the questions that popped into my mind and covered them off. Good use of links and a relevant picture that wasn’t just window dressing! Perhaps my favourite article so far :) Keep up the great communication.


Ashley Alexander February 26, 2012 at 6:26 pm

Thank you for the comments, Michelle!

Patricia February 26, 2012 at 1:29 am

Love your post, and the title!!! I think you get the attention from the start. Clear information and easy to read.

Ashley Alexander February 26, 2012 at 6:25 pm

Thanks, Patricia!

Darlene Varaleau February 26, 2012 at 8:52 pm

When I reached menopause I started losing bone density at a rate of 7-8% a year. My doctor favored Evista over bisphosphonates but rather than relying on medication, I am currently taking a generic vitamin/mineral program that includes calcium, magnesium, vitamin D, vitamin K2 and strontium. My bone loss dropped to 1.5% annually (which I still don’t like) but at the time of the last test I was still in the rapid loss period around menopause. I am looking forward to my next DEXA test this Fall which will reveal if I have succeeded in actually rebuilding bone which many people have achieved with vitamins. One of the most shocking things I discovered was how much vitamin D is required to maintain optimal blood levels for calcium absorption. I now take 5,000IU during the winter and that seems to be working perfectly through a Canadian winter.

Ashley Alexander March 5, 2012 at 11:28 pm

Thanks for sharing, Darlene. Good to know there are alternatives out there to medications in case future studies do prove these risks are serious.

Angela February 27, 2012 at 9:34 pm

Thank you for this post. Found it very interesting & you get the problem across very clearly. Curious about follow-up studies!

Ashley Alexander March 5, 2012 at 11:26 pm

Thanks for reading, Angela! I, too, am curious to know what will be discovered in future studies of these drugs.

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