If you have been taking a bisphosphonate medication, have you been concerned about recent studies stating possible complications with long-term use?
Bisphosphonates (a class of drugs that prevent the loss of bone mass) have been used since the 1990s in the treatment of osteoporosis in postmenopausal women. They include drugs like alendronate (Fosamax), risendronate (Actonel) and ibandronate (Boniva). With long-term use there are concerns about potential complications like atypical femur fracture (a fracture that occurs on the femur, also known as the thigh bone, that is associated with no trauma or minimal trauma such as a fall from standing height or less), esophageal cancers and jaw osteonecrosis (bone death caused by poor blood supply to the area). In fact, dentists may recommend stopping the medication for a period of time before a dental procedure, due to concerns about jaw osteonecrosis.
According to a recent trial*, stopping alendronate after five years of therapy showed a slow decline in bone mineral density, but no significant higher risk of fracture, except clinical vertebral fractures. Thus stopping bisphosphonates may be reasonable in low-risk women—those with no history of vertebral fractures and with bone density scores (T-scores) better than -2.5. This study did not address the impact of stopping therapy in women at the highest risk for fractures, and with T-scores below -3.5; hence, continuing alendronate for up to 10 years is an option for high-risk patients.
If you are taking, or considering taking a bisphosphonate, you should be aware of the possibility of atypical femur fractures and:
- tell your healthcare provider if you have new thigh or groin pain (to rule out a femoral fracture that can occur weeks or even months before a complete fracture occurs).
- expect that your healthcare provider will periodically re-evaluate whether continued bisphosphonate therapy is needed, especially if you have been treated for more than five years.
- discuss the benefits and risks of these drugs with your healthcare provider.
More about Calcium and Vitamin D
Taking calcium and vitamin D can result in a positive calcium balance and can help to prevent osteoporosis.
In post menopausal women, taking 1200 mg of elemental calcium daily (total diet plus supplements), along with 800 IU (International Units) of vitamin D daily, is suggested.
Individuals with vitamin D deficiency require higher doses of vitamin D. For vitamin D supplementation, vitamin D3 (cholecalciferol) is recommended over vitamin D2 (ergocalciferol). The safe upper limit for vitamin D3 is 4000 IU daily.
In most individuals, calcium carbonate taken with meals is adequate for calcium supplementation and is an inexpensive preventive measure. However, for patients taking proton pump inhibitors or H2 blockers calcium citrate is recommended. The total intake of calcium (diet plus supplements) should not routinely exceed 2000 mg/day.
Please note the dose of calcium and vitamin D may vary in individuals with coexisting medical conditions.
*The Fracture Intervention Trial Long-term Extension (FLEX): A Randomized Trial
WHERE TO GET MORE INFORMATION: www.uptodate.com/patients, www.nlm.nih.gov/medlineplus/healthtopics.html, www.osteo.org, www.nof.org, www.healthywomen.org, http://www.osteoporosis.ca
REFERENCES:
http://www.uptodate.com/contents/bisphosphonates-in-the-management-of-osteoporosis-in-postmenopausal-women?source=search_result&search=bisphosphonates&selectedTitle=1%7E150; JAMA. 2006;296(24):2927-2938 (doi:10.1001/jama.296.24.2927); Dennis M. Black; Ann V. Schwartz; Kristine E. Ensrud; et al.
Menopause: The Journal of The North American Menopause Society; Vol. 18, No. 10, pp. 1072/1078; DOI: 10.1097/gme.0b013e318215101a; 2011 by The North American Menopause Society
Osteoporosis screening and treatment guidelines: are they being followed? Peter F. Schnatz, DO, FACOG, FACP, NCMP,1,2,3,4 Kimberly A. Marakovits, BA,1,5; Melissa DuBois, MD,1 and David M. O’Sullivan, PhD1; BMJ 2010;341:c4444; J Clin Endocrinol Metab 90: 1294–1301, 2005
