As an Orthopedic surgeon, I have always used the expression “does it make sense?” when thinking about treatments. Bisphosphonate treatment for osteoporosis just doesn’t make sense.
Bone is a dynamic tissue—it is constantly changing, building up new bone to replace old and damaged bone. Osteoporosis commonly results when bones breakdown faster than they can build up. Bisphosphonates are a non-specific treatment that block bone turnover. Early statistics in cases involving these drugs show a significant reduction in new fractures. But there are other, more serious consequences of blocking bone turnover.
In a recent study, researchers found that more than 50% of patients who were prescribed these drugs for more than 3 years following a femur fracture broke their other femur. Those who discontinued using the drug early on broke their other femur less than 20% of the time.
The drug’s long term effects were completely predictable. This drug is designed to prevent bone fractures, and is mostly prescribed to older patients. But after 3 years on the drug, the risk of fracture starts to increase, and at this point it may already be too late to reverse the damage of years without bone turnover.
In my opinion, doctors should encourage more natural ways to increase bone mass in all patients, both young and old. Weight bearing exercise, smoking cessation, and improved Calcium intake and Vitamin D levels are small but effective methods. Additionally, patients with osteoporosis and a greater than 5 year life expectancy should consider other options that work to build bone without stopping turnover, such as Calcitonin supplementation and Forteo (teriparatide).
Related Sources:
Medscape.com