Osteoporosis Drugs May Up Your Risk of Some Fractures

Osteoporosis drugs known as bisphosphonates (Fosamax and Boniva are two brand names) are known to prevent the loss of bone mass and prevent fractures due to osteoporosis, so they've been widely prescribed to menopausal and post-menopausal women over the past decade plus. But at some point doctors started to report that women taking these drugs were experiencing unusual thigh fractures, and now a new study has found that the link isn't a coincidence.

Although these drugs increase bone density, decreasing the risk of the more common osteoporosis-related fractures, they also make bones more brittle, which can lead to these other, more unusual fractures. The research, published in the latest edition of the Journal of the American Medical Association, found that women who take bisphosphonates for five years or more were significantly more likely to suffer a fracture of the femoral shaft (a thigh bone) or a subtrochanteric fracture (which occurs in the bone below the hip joint).

The researchers were quick to point out that these fractures are still quite rare, and that women at high risk of osteoporosis shouldn't stop taking bisphosphonates. But they also say that for women with relatively low risk of osteoporatic fractures, "long-term use of these drugs may warrant reconsideration."

I was curious about how these "atypical" thigh fractures are most likely to occur, so that readers who take bisphosphonates might be able to prevent them, so I asked Dr. Tim Carlson, lab director at Pacific Biomarkers in Seattle, who has done research related to bisphosphonates. "These fractures are often associated with prior thigh pain, but they usually occur without trauma at the time of fracture," he told me. But Carlson added, "The risk of these fractures is still very low, about .3%. On the other hand, the reduction in risk of typical hip and vertebral fractures associated with osteoporosis has been found to be as high as 35-70% during bisphosphonate treatment."

Of course, as with most prescription drugs, there are dissenting doctors who say that the risks and side effects far outweigh the benefits, for everybody. For instance, Dr. Dale Peterson, author of the book Building Health by Design, says that bisphosphonates not only up your risk of thigh fractures, but also can bring nasty side effects including severe joint, bone and muscle pain, nervous system disorders and even kidney failure (though the kidney failure is rare, and only reported from the use of the intravenous versions of the drug, not the pill form). Plus, these drugs might pose another danger that's scarier than a broken leg: An increased risk of esophageal cancer, according to a study published last fall in the British Medical Journal.

Hmm, all of this leaves me leery of these drugs. I'm thinking it might be worth the risk to take them if you have full-fledged osteoporosis, but if you're still at the osteopenia level (meaning your bones are thinning, but not osteoporotic yet) it might make sense to try other bone-strengthening techniques instead. For some ideas on natural osteoporosis prevention and treatment, check out the website Better Bones. This site purports that the best way to strengthen bones isn't to take drugs or drink more milk, but to consume a diet that reduces acidity and promotes alkalinity in the body (the two-second summary: eat more vegetables).

Do you take bisphosphonates, or have you in the past? What was your experience?