Q. I am not yet 50 but my doctor says I have something called osteopenia, which could put me at risk for osteoporosis. She has suggested Actonel, but says this decision is up to me. She mentioned that there are some side effects and questions about the quality of the bone that results from this type of treatment. Is it possible that treated bone might not be as strong as that which grows naturally? What else can you tell me about these drugs?

A. There is growing controversy about osteoporosis drugs such as Actonel, Boniva, Fosamax and Reclast (Journal of the American Medical Association, Feb. 18, 2009). Rare but serious complications such as jaw problems, severe muscle, bone and joint pain and unusual thigh-bone fractures have been reported.

One reader shared this story: “I had a right femur fracture in May, 2007 and a left femur fracture in February, 2008. I had been taking Fosamax or Actonel for about 10 years. Prior to breaking these bones I had unexplained thigh pain for several years.”

It seems paradoxical that drugs meant to strengthen bones might contribute to unusual fractures. So you can better understand this issue and other pros and cons of osteoporosis treatment, we are sending you our Guide to Osteoporosis.

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  1. MCH

    Hi Shannon, how much K2 and Strontium Citrate are you taking?

  2. patti

    I am a 57 year old female. I had a hysterectomy in 2005, took hormone therapy and developed breast cancer and now take no hormone (am cancer free now thank God!). Last December I torn the meniscus in my left knee. I finally had surgical repair done in May and healed well. Seven weeks after that surgery I went and walked around our local Walmart and grocery store for a couple of hours. Later that day I began having severe swelling and excruciating pain in my left ankle.
    By the next day I couldn’t bear weight on it at all. Saw an orthopedist and it was determined that I had a stress fracture in my tibia right above the ankle. It still has not healed totally and it’s been 3 months. I had a bone density test and I have now been diagnosed with osteopenia in one hip and between L1 and L4 of the spine, but my doctor told me to chew 4 tums a day and take nothing else for it.
    I’m REALLY concerned that my fracture was a result of the osteopenia. Has anyone else out there suffered stress fractures? I don’t know my T score.

  3. O.I.

    I have been taking Boniva for years. Lately my right hip became quite painful. After seeing a Chiropractor for a consultation I was made aware of the fact, that Boniva could be the culprit, however, at my age -85 – it could be also a degenerative condition. The doctor told me I would have to be off Boniva for 6 month until I could take care of two root extractions.
    Wow! No one in the medical society makes you aware of the danger of taking Boniva. Was it not to be a miracle medicine that would take care of the osteoporosis?

  4. Shanon

    I am an active 69 year old woman, I was diagnosed with osteopenia 5 years ago despite a healthy life style.
    I researched my options and went to a naturapth.
    My regimen for the last 5 years has been strontium citrate, K2 drops, lots of vitamin D & calcium citrate. All these supplements are OTC and I have had no side effects. I am a long time exerciser, but I have increased working out with weights.
    My last bone scan showed significant improvement in my hips and spine.

  5. MM

    I have come to the conclusion that many doctors are rewarded handsomely for prescribing drugs. I don’t have proof of this, but they often scare you into taking medications that create other problems, hence more medications are necessary.
    It’s a crime that so many older adults are trapped into these medical jigsaw puzzles, spending thousands of dollars a year on pills.
    I’d like to find out if my theory is correct. Anyone have a common thought on this?

  6. D.D.

    I took Actonel for the first time last weekend. About 24 hours after taking the medication, I was in so much pain. I was having severe chest pain. I also had horrible back, muscle and joint pain. It reached the point that I needed help walking to the bathroom. The pain was so bad that I was vomiting.
    I ended up going to the emergency room and spending the night in the hospitalize due to the side effects. It has almost been a week later and I am still having symptoms from this medication. I recommend that you have someone stay with you if you plan to take this medication. It could be very dangerous.

  7. Mary M.

    My doctor also said I have mild/moderate osteopenia, (more in my spine than in my hip) and I’m looking into other treatments besides Alendronate, which he prescribed for me. I’m almost 57, I eat well, exercise a lot, so I’m wondering if they’re just being cautious and want to go on the record for recommending this medication so he doesn’t get sued.
    At what point to most people go on Fosamax or something similar, or have any of you tried other treatments?
    I’m looking into liquid calcium, upping my D to 2000 a day…I’ve even heard about an herb called epimedil (HEP) and Horny Goat Weed.
    I almost went on Vioxx a few years ago, and I’m glad I didn’t! I’ve read about these side effects with these drugs, and I’m very suspicious about taking them.
    Any input would be appreciated!

  8. MCD

    I am also interested in what brand of Strontium and bone growth mixture you are using and where you bought it. I am currently recovering from an ankle fracture. I have rheumatoid arthritis and osteoporosis and have been on Fosamax for probably 12-13 years. My rheumatologist thinks the fracture may be due to the long term Fosamax usage.

  9. MCH

    Hi JP,
    what brand of Strontium and bone growth mixture are you using, please? My doctor said I have osteoporosis and mailed a prescription for Fosamax, but after reading everything there is out there, I’m afraid to take this long term. I don’t want to damage the bone that’s left.

  10. MWT

    I have just started taking Alendronate Sodium….today was the 2nd time. Last week, after taking the pill for the first time, I had chills that night… according to the Pharmacy information sheet…. flu-like symptoms are in the beginning…. however, I also discovered the next day, I could only do one lap in the pool; whereas, normally I do about 4 laps for exercise. However, within a few days, I was back to my normal exercise routine.
    I discussed this with the Pharmacist, and she recommended that I give it another try….it will be interesting to see if I still get the same reaction.
    Consequently, I am curious if your husband has had any side affects also via this medication…Thank You. …MWT.

  11. ejy

    In 2001, after falling and breaking an ankle, the orthopedic surgeon did a bone density test and had me start fosamax. Within 60 days I developed neck pain and loss of flexibility in my neck. I first thought it was connected to my fall. I continued the fosamax through the 2 year prescribed period.
    A new bone density test showed no improvement. I suggested to my doctor that fosamax might be a problem so he prescribed Actonel instead. I checked the labels and they both had the same ingredients. I stopped all medication and within 90 days all pain was gone and I had full range of motion. The doctor dismissed it as coincidence. I do not think so! Thank you for your time, Ed Y

  12. Joan M.

    I have been on Actonel for 5 weeks for osteoporosis..I developed an incapacitating severe lower back pain which required my needing assistance to get out of bed or even a chair….I stopped Actonel after studying other people’s results (many of which were the same) and will try the strontium citrate next. Years ago I tried Fosamax and developed a hip problem which seriously affected my ability to walk. Have you any research on strontium citrate?

  13. LK

    I’ve been on Zometa for 8 years.
    Both my thighs cracked May, 2008. Since then, both femurs broke and had surgery to insert rods & screws.
    My Oncologist didn’t know about this side effect from Astra-Zeneca (manufacturer of Zometa) in their literature.
    Additionally, I went to an Endocrinologist. I have low Vit D levels and was told to take 50,000 iu every week for 8 weeks, then monthly to bring bone level to normal.
    Where is this fracture information written?

  14. JP

    I had osteoporosis but refused any rx bone drugs because of side effects and doubts about their effectiveness. I take strontium citrate daily (not at the same time as calcium) and for 3 years my bone density scans have improved. I now have osteopenia and expect to continue to improve. And no negative side effects. Strontium is one of the ingredients needed for healthy bone growth and I also take a bone growth over the counter mix.

  15. A.D.

    I’m having jaw and tooth problems after taking Fosamax, then Boniva for a total of about 10 years. One dentist who was aware of the side effects of such meds. says Actonel is the worst of these, and a friend confirmed she had to be hospitalized after taking this for a while. I have an abscessed wisdom tooth the oral surgeon will not remove until the level of Boniva reduces.
    Now am on the third RX of penicillin and clindamycin to fight the infection. The pain has been very bad at times. I have been off the meds. since November. I’m hearing of more and more people having problems. One doctor I know of only keeps a patient on these meds for a few months at a time.
    Having said that, my bone density test shows great improvement.

  16. smd

    I had osteopania. I was in a trial for Vitamin D. First they tested my Vitamin D levels and discovered that they were low. Then I was on a 6 months study where first I took 400iu of vitamin D3 every day and 50,000iu of Vitamin D3 weekly for 2 months. Then it switched to 400iu of vitamin D3 daily and 50,000iu of vitamin D3 monthly. At the end of the 6 month study my bone density was back to normal and I no longer had osteopania. I now take 2000iu of vitamin D3 daily. Before taking any osteoporosis drugs or Vitamin D you should have your blood levels of vitamin D tested. It could be a simple fix.

  17. cn

    Celiac disease may cause osteopenia because it causes vitamin D and fat issues. This was my issue. I am feeling a lot better off gluten for 3 months. My levels of vitamin D are up now. I lost five teeth because of osteopenia in my 40’s.

  18. LMM

    I was diagnosed with osteopenia 10 years ago. I was on Actonel for 7 years, at which time my doctor put me on Forteo. I have stress-fractured at least a dozen bones in both feet. Get treatment before this happens to you.

  19. Ruby

    With all of the problems my husband and I have had With poor quality generics I wonder how well the generics like bone medication work to prevent problems that we are not aware of. My husband has DMD so he has to take prednisone which weakens bones so he also takes Fosamax and since about 2 yrs ago now takes the generic Alendronate Sodium.
    I am concerned that he may not be getting the bone protection he needs. How does anyone know how well preventative medication is working when the generics have failed us with the medication that we are aware of (antidepressants, stomach medication). We cannot afford this may or may not but it saves money. I hope that I have been able explain my point. I would like to know if anyone else has thought about this or if anything is being done to see if generic preventative medicine does as good as the name brand.

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