The People's Perspective on Medicine

How to Avoid a Fracture by Changing Your Medicines

Many older people who suffer a fracture are taking drugs that may contribute to their risk. Changing their medications might help them avoid a fracture.

Older people who break a bone are at a significantly greater risk for another fracture. This also increases their chance of premature death, as well as pain, infection, depression and functional decline. How could they avoid a fracture?

How Doctors Should Help Patients Avoid a Fracture:

The logical thing for doctors to do, say researchers writing in JAMA Internal Medicine, is review the list of prescription medications people are taking when they break a bone. Then the doctors ought to change those drugs that could raise fracture risk.

Unfortunately, that doesn’t seem to happen most of the time. The investigators reviewed the Medicare Part D prescription drug records of more than 168,000 older people who had broken a bone.

Drugs That Disrupt Balance:

They found that about three fourths of these individuals were taking drugs that could predispose them to fracture. Some were taking sleeping pills such as zolpidem (Ambien) or benzodiazepine anti-anxiety medicines such as alprazolam (Xanax) or clonazepam (Klonopin). Drugs of this sort can lead to unsteadiness.

Other drugs that may affect balance include antidepressants, especially SSRI-type drugs such as fluoxetine (Prozac) or sertraline (Zoloft). Many common blood pressure medications, including thiazide diuretics like hydrochlorothiazide, can cause dizziness. Blood pressure pills like clonidine (Catapres, Kapvay) or guanfacine (Intuniv, Tenex) often cause lightheadedness or even fainting if a person stands up suddenly.

Drugs That Weaken Bones:

Other people in the study were taking inhaled corticosteroids for asthma or COPD. More than a quarter were on acid-suppressing drugs that weaken bones. These are PPI medications such as esomeprazole (Nexium), lansoprazole (Prevacid) or omeprazole (Prilosec). Anticonvulsants can also undermine bone strength.

Ask Your Doctor to Help You Avoid a Fracture:

It is disappointing that very few of these prescriptions were changed even after a nasty fracture. Perhaps the doctors who prescribed the medication were not the ones who took care of the patients when the fracture occurred. If doctors are not thinking about this problem, patients may need to bring it to their attention.

People who have broken a bone should ask their doctors to review all their medications to avoid a fracture in the future. Using alternatives to the riskiest medicines could reduce the likelihood that drugs for indigestion, insomnia or hypertension will increase the chance of another fracture. A medicine designed to improve bone strength such as alendronate (Fosamax) might also be considered. Such changes should be made only under a doctor’s supervision.

JAMA Internal Medicine, online Aug. 22, 2016 

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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After breaking my wrist at age 72, my doctor prescribed Fosamax. Within a few days my blood pressure went up from 125/75 to 155/100 and after ten days to 175/115. Needless to say I stopped to Fosamax, after which my blood pressure turned to 125/75.

Thank you for sharing this information.

Thanks Maria from Florida (August 26th, 2016).
I totally agree with you.

I started to look at Fosamax in 2005 because my mother was on it. She was over 80 at the time, had no osteoporosis but had become slightly shorter (natural). She had no previous fractures either – but Fosamax was in the news.

When she had been on Fosamax (alendronate) for some years – she broke her hip in spite of the medication and a very little “accident”.

I “discovered” the book – The Myth of Osteoporosis – by Gillian Samson. (It was revised in 2011) My mother stopped Fosamax after some time and hasn´t broken anything since then. She is 96 now and still living an independant life.

Since 2005 I have followed the “bisfosphonate-story” and in 2010 I read an article from Finland (I live in Sweden). A patient asked – “Osteoporosmediciner – varför ska man hålla en paus?” (translated: Osteoporosis medications – why should one take a break?)
The question was put to a doctor and I have translated/interpreted part of his reply.

Bisfosphonates are a good first choice for osteoporosis. After medicating for 3-5 years the bone…………… will be hard och brittle and the risk for fractures increase.
After 5 years, at the latest, you should, therefore, take a break if you use bisfosphonates. At this stage (end of 2010) we don´t know how long this break should be before the bisfosphonates can be used again.

I think it`s important to read different, critical books and try to make up your own mind.
Much of the research/information come from the pharmaceutical industry and they may not look at it in the same way. Here are a couple of other books that I would like to recommend.

Allan Cassels, a Canadian researcher/author, has written about osteoporosis in his book about different types of screening – Seeking Sickness – Medical Screening and the Misguided Hunt for Disease. You will also find other articles on the Internet. Just google his name and osteoporosis for instance.

Pharmacist Armon B. Neel has devoted one chapter to osteoporosis it in his interesting book – Are your prescriptions killing you?

All bisfosphonates, whether in pills or injections, seem to have similar side effects.
Here is a mixture of substance and product names from the Finnish article. I am sure you will recognise some.
Alendronate, Bonviva, Didronate, Fosamax, Fosavance, Optinat, Risedronat and Riseos

I know someone who got necrosis of the jaw bone on Fosamax ! I’d say only use if you do NOT have any teeth left. Only use for 5 years.

Cannabis tincture or oil is known to help healing of one fractures and can make any break stronger after.

I was in a critical state in a hospital when my niece brought me an article from Consumer Reports that said the FDA had issued an alert saying fluoroquinolones should not be used unless other options have not worked. It can cause nerve damage and ruptured tendons. Furthermore the article said that the first option should be amoxicillin. I was on fluoroquinolones IV for 2 days. I showed the article to the doctor and he discontinued it. Seemingly my tendons are intact but my nerves are a little shattered from this ordeal. Hospitals make so many mistakes. Another drug to watch is heparin. I am extremely allergic to heparin and my platelets plummeted down to 43 before it was determined not to be a “lab mistake.” Now I must give myself belly shots for 60 days before a decision is made on the next step. Hospitals have become a scary place for me.

I had been taking Fosamax for years, for osteopenia, and still developed osteoporosis for which I am now receiving Prolia injections q 6 mos. Should I still be taking the Fosamax? NM

I think doctors, in general, give patients too much medicine, especially to older people. Many times, places like People’s Pharmacy have alternatives that work just as well. Also, the food we eat is powerful in determining our health. I think the medical professionals does go a bit overboard in taking away the only the thing that can lessen the awful emotional pain of anxiety. They should listen to the patient as to the pros and cons of how careful he or she is.

Using a walker does a great deal to lessen falls. The patient who still has their good mind often uses good judgement in how much valium or xanax they can take and still be in charge of not falling. Older people have many reasons for being depressed or anxious, especially in knowing they cannot have a choice in deciding when living is no longer worthwhile. Our animals are treated better. Sure, we can have a declaration of natural death legalized, but that is mostly used after the patient is no longer alert or functioning. If only doctors could spend a few more seconds with the patient and individualize their treatment–not a one size fits all. Also, drugs that one does not have to take every single day are safer.

I thought Fozamax shots had way too many side effects?

Through personal experience dealing with the all too frequent sleeplessness accompanying bipolar disorder, all the sleep drugs cause memory loss when used regularly. After a year or so of using one particular sleep drug, I showed up at my psychiatrist’s office three different times for the same appointment. This was simply a well check visit, but I was not as “well” as I thought. I now use a very small dose of my antipsychotic when needed for sleep.

I very much appreciate and read the People’s Pharmacy and use the information you provide. But, I have a frustration, that the links provided are often just an abstract from a medical journal, the full article is only available to subscribers of that journal. In the case of the above JAMA article, the abstract does say that this study was made but does not mention any of the medications studied. Thank you for mentioning the medications in your article; you provide valuable information to the public. I just wish these journals were more accessible. Thank you, Betsy

I’m surprised you would suggest Fosamax given biphosphonates have been proven to build brittle bone, cause spontaneous fractures of large bones such as the femur, necrosis of the jaw, etc.

There are far better natural ways to build and maintain the tensile strength of bones.

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