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Bones are getting a lot of buzz these days. For one thing, TV commercials promoting osteoporosis drugs like Boniva and Reclast create an image of healthy activity.
Watch television and you are likely to see Sally Field watering her flowers, romping with her dog or playing Twister with her grandchild while she boosts the benefits of Boniva.
Then there is the forensic anthropologist and best-selling author Kathy Reichs. The popular TV show "Bones" is based on her series of thrillers. Now Dr. Reichs is a spokeswoman for an osteoporosis awareness program called "Know My Bones."
Not surprisingly, a pharmaceutical company is supporting this initiative. Amgen, the maker of a new osteoporosis drug called Prolia (denosumab), is hoping for rapid FDA approval.
Bones are big business. Nearly $5 billion is spent on medications like Actonel, Boniva, Fosamax (available generically as alendronate) and Reclast. These medications are known as bisphosphonates. They work by slowing the natural breakdown of bone by cells called osteoclasts. This allows bone-building cells (osteoblasts) to catch up a bit and improves bone mineral density.
Prolia also slows bone loss, but through a different approach: it prevents formation of osteoclasts so the body makes fewer of them. A new study shows that Prolia injected twice a year cut the rate of fractures of the vertebrae from about 7 percent to just over 2 percent (New England Journal of Medicine, Aug. 20, 2009).
You can tell the competition is strong by the fact that Amgen officials have been pointing out weaknesses in the Fosamax record: the drug has been linked to jaw bone death, a serious though apparently rare side effect.
Bisphosphonates are also linked to incapacitating muscle and joint pain as well as digestive tract irritation. These drugs are incorporated into bone and may make it more brittle with time. Some long-term users have recently reported broken thigh bones.
Readers have reported experiences similar to this one: "I read your column on unusual femur fractures after taking Fosomax for 5 years or more. I broke my right femur in May, 2007, and the left femur in February, 2008. I've taken Fosamax or Actonel for about 10 years. For four years prior to the fractures I had thigh pain for which no reason could be found."
That doesn't mean Amgen's new drug is perfect, though. The committee advising the FDA was concerned about a slightly increased risk of infection and cancer among patients given Prolia.
Although bisphosphonates have the lion's share of the osteoporosis market, there are several other strategies against osteoporosis that may be more appropriate for some people. We discuss the pros and cons of these medications and non-drug approaches in our Guide to Osteoporosis.
Since patients may be taking bone drugs for many years, they need to know the long-term benefits and risks of such medications.
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Upon reading this article about osteoporosis I was pleased to see it as a confirmation of my doctor's professional advice. She strongly advised me to stop calcium and Actenol for all the above reasons. I followed her instructions only because she's my health-care provider but secretly didn't feel comfortable doing this drastic change.
It's been a year now and my bone density test has actually improved. I incorporated walking 60 minutes every day and this may have helped. Thank you for being on top of the best health-care for us seniors, we need you. I'm 64 and want to live my best life as long as I can.
Thanks for your attention to this issue. It's very troubling.
I took Actonel for awhile (less than a year). My doc advised me to stop taking it after I fractured my collarbone in an accident (which would have broken anyone's bone). It wasn't healing. She told me to discontinue the actonel because it stops bone remodeling (which is necessary for bones to knit). It healed normally thereafter.
The orthopedic specialist I was seeing wasn't aware that the bisphosphanates had an effect on bone healing, which blew my mind. Needless to say I "fired" him (by not returning to see him). He's a successful and fairly prominent ortho too.
When I resumed taking the drug, I experienced deep and severe bone pain. I quit taking it for good. I became concerned about the idea of mineralization bones and causing them to be more brittle.
A close friend (on fossamax for 10 years) suffered a nasty fracture of the femur similar to those reported) in a rather trivial fall (for a 59 year old), and it wasn't healing. No one told her to stop the Fosamax. I advised her to ask her doc about doing so.
Jean:
You also stopped calcium? Do you take anything instead?
I just finished my 4th week (once a week) of fosomex. I was diagnosed with 2.4 in my right hip-I really hate meds and I am also on a low dose (.5- 3 x a week) of lipitor and 1 baby aspirin 3x a week.
After I started the lipitor I became aware of a mild discomfort in the top of my femur- I know that a side effect of lipitor can be joint pain-
I need opinions-----
thanks
I've been taking Fosamax for the last 12 yrs at least (I'm 45). This summer I had some acid reflux and a weird feeling in my esophagus. Turns out I have Barrett's esophagus, which is a pre-malignant condition of the esophagus. I feel very fortunate that my GP picked up on this, told me to stop the Fosamax, and sent me to a specialist, who did an upper endoscopy.
I could have ended up w/ terminal esophageal cancer in a few more years if I'd continued on the Fosamax. Altho the GI doc doesn't think the Fosamax caused my Barrett's, the doc who ordered the Fosamax does think so. Either way, no more Fosamax for me. Should I need to continue with bone-builders, it will be Reclast now.
I am a 72 year old female, diagnosed with osteoporosis in my 60's, despite my years of diet, exercise, and supplements. I was prescribed Actonel for three years, but had to discontinue the drug because of esophageal issues. In November of 2007 I had my first Reclast infusion, and my second in November of 2008. I experienced mild, flu like symptoms for 36 hours afterwards, but felt fine after that with no joint or bone pain.
My latest bone density scan showed a 10% increase in the hip area, and a 21% increase in the spine as compared to the numbers before the Reclast infusion. I understand there can be serious side effects, and carefully read all the available information, but at the current time, Reclast seems to be a good solution for me.
Thank you so much for providing all the information you do about the many health issues facing us. Your information helps us to be educated, and better able to make informed decision about our health. Sorting through the truths, half-truths, and outright falsehoods can be a full time job. Thanks to you, it can be done.
I'm 59 and been on fosamax for 15 yrs. I've got pain in my rt. gluteal buttock that requires advil 2 tabs once a day with 50% relief. I had a MRI and the radiologist said nothings wrong but MRI's don't show arthritis. What do you think?? I stopped fosamax one week ago..
What do the studies show on the combination of Evista and Reclast?
I was put on Boniva for osteopenia. Within 4 months my jaw & teeth had severe pain. The doctor diagnosed me with trigeminal neuralgia, which was incorrect. The Boniva had abscessed my teeth.
After a root canal on my tooth, stopping the Boniva & a racing heart for 6 months I got back to normal. I really think I would not be alive if I had continued the Boniva. I also had bad side effects from Foxamax & Actonel. I have since learned they are all bisphosphonates. If you have problems with one you most likely will the others.
I have used Miacalcin for 10 years & just learned about the brittle bones after taking them to long. I was having hip pain also. Since I stopped using the Miacalcin
my hip pain is much better. Your articles are very helpful. I heard about your website on Murray State Public Radio.
Once again the drug companies found another way to make money off of women's ailments and women are the experiments! I am seeing an endocrinologist in a few weeks and expecting the "push" for one of the bisphosphonates. After reading & researching all of the drugs & side effects, I will "push" for a natural way to increase bone density.