When bone-building medications known as bisphosphonates were introduced 18 years ago, they were hailed as near-miracle drugs for people with thinning bones. Studies showed that these drugs—first, alendronate (Fosamax) and later, risedronate (Actonel), ibandronate (Boniva) and zoledronic acid (Redast) significantly reduced the incidence of hip and spine fractures in people with osteoporosis and osteopenia (bone loss that is less severe than osteoporosis).
Now: Despite the established benefits of bisphosphonates, the medications are increasingly coming under fire for having potentially serious side effects. For example, studies have shown that the drugs may increase risk for various conditions, such as breakage of the femur (thigh bone), osteonecrosis (death of bone tissue) in the jaw and even esophageal cancer.
Two FDA advisory panels recently wrote in a report that due to the potential risks associated with long-term use of bisphosphonates, bisphosphonate therapy could be safely discontinued in some cases—but did not specify when or for how long to discontinue the drug.
Studies on the safety of bisphosphonates are ongoing. Thus far, the research is mixed on the benefits of taking the drug for more than five years. For example, research has shown that women who took Fosamax for another five years (for a total of 10 years) had the same rate of femur fractures as those who took a placebo. The risk for spine fracture, however, was higher in the group taking a placebo.
Finding The Best Treatment
The decision to take bisphosphonates (or any medication requires balancing benefits against risks. People at high risk for fractures should not stop taking these medications but instead work with their doctors to determine the duration of treatment. This includes people who have had previous fractures or a family history of fractures...and those with rheumatoid arthritis, which can increase bone loss. Other high-risk individuals include those who take the corticosteroid prednisone for a chronic condition... women who weigh under 127 pounds....people who lead a sedentary lifestyle (weight-bearing exercise strengthens bones).and smokers (their risk for bone loss is twice that of a nonsmoker).
Women and men who have a high risk for fracture but who have other health concerns may want to talk to their doctors about taking a non bisphosphonate bone-strengthening medication. Examples…
Denosumab (Prolia), a monoclonal antibody that reduces the body's bone-breakdown mechanism. If you have gastroesophageal reflux disease, this drug, which is delivered via an injection, may help you avoid the gastrointestinal side effects common with bisphosphonates. However, in a few rare cases, osteonecrosis of the jaw has been reported.
Teriparatide (Forteo), a type of parathyroid hormone that builds bone. This injectable drug increases bone thickness, so if you have a history of periodontal disease, you may be better off with this drug.
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