The Effect of Biphosponates as Treatment for Osteoporosis

This week the Food and Drug Administration (FDA) issued a report on the long term use of biphosponates-the main class of drugs prescribed to treat osteoporosis. 

Sold under various brand names (i.e. Fosamax, Boniva and Reclast) these medications are given at the time of diagnosis, but whether therapy should be indefinite or time limited is not clear.

Osteoporosis, or “thinning of the bones” is a major health threat to millions of Americans.  The prevalence of disease increases with age, particularly in women who have gone thru the menopause and have lost the hormonal environment that helps maintain bone health during their first decades of life. The main threat from the condition is fracture of the bones-hip, vertebral (back bone) and wrist fractures being the most common.  And the problem doesn’t stop there-of the 80,000 men (yes, osteoporosis affects both sexes!) who suffer a hip fracture, one-third die within a year from a variety of complications!

There are a number of risk factors that contribute to osteoporosis. Those beyond your control are gender (women are at higher risk than men), age, body size (small women at greater risk), ethnicity (Caucasian and Asian at higher risk than African-American and Hispanic) and a family history of the disorder. Risk factors which we have control over are low calcium and Vitamin D intake, an inactive life style, alcohol and cigarette use.

The caveat from above is that we all should take active steps to maintain healthy bones-exercise and avoid cigarettes and excessive alcohol use. An adequate intake of calcium is essential—the average adult should be taking in 1000-1200 mg/day. This should be supplemented by 400-600 IU per day of Vitamin D.

Screening for osteoporosis is available. The most commonly used test is a DEXA scan-a special x-ray used to measure “bone density”. In general this test is recommended for women at the age of 65, but each patient’s individual risk for osteoporosis should be discussed with their primary care physician. To assess your own personal risk, click here.

For patients diagnosed with osteoporosis, or its forerunner osteopenia (early thinning of the bones), there are multiple treatment options.  Although biphosphonates are often used, the right approach for you would be tailored to your own overall health and condition.

The FDA report this week was influenced by two recent studies, which showed that the bone fracture preventive effects of biphosphonate therapy attenuated after 3 or 4 years.  When one takes into account that these medications have rare, but serious side effects, there is a question of who should continue to take the medication for a longer period of time. Most experts would recommend that patients with bone scans showing continued significant osteoporosis at the end of four years of treatment are probably the best candidates for long term therapy.

If you take one of these medications, please speak with your primary care physician. If you would like to make an appointment with an Endocrinologist expert in bone health at Nassau University Medical Center, please call 516-572-4848 for an appointment.