Osteoporosis drugs causing bone fractures?

For most of us, our bones naturally become more dense as we age, at least until we hit our thirties.  After that, our bones gradually decrease in density, and when they decrease enough we call it osteoporosis.  Unfortunately, the decrease in bone density is faster in post-menopausal women, smokers, patients taking steroids, and sometimes those with a family history of osteoporosis.  Therefore women over 50 and men over 60 should consider being screened by having a bone density x-ray test; a DEXA scan.

As for treatment, the guidelines are pretty clear as to who will benefit from bisphosphonate drugs.  Unfortunately, there are NO guidelines as to how long we should take these medications, and some data suggests that long-term use of bisphosphonate drugs can paradoxically increase the risk of bone fracture.  But how long is “long term,” and how can a drug meant to reduce the risk of bone fractures actually cause them?

While our bones may seem rather stable, they are actually in a constant state of microscopic flux; old bone being broken down, and new bone being created.  In osteoporosis, the balance is disrupted and the overall density of the bone decreases with time. 

These medications decrease the normal turnover of bone, and have been shown in many studies to improve bone density and decrease the risk of bone fractures.  Some surmise that this may also decrease the healing of micro-fractures that can accumulate over time

The good news is that bisphosphonate drugs last a LONG TIME in the body, so when one stops taking them, their protective effects continue.  If you have osteoporosis, the evidence continues to show that these drugs are helpful for reducing the risk of bone fractures.  However, if you have been on bisphosphonates for five years or more, talk with your doctor to see if stopping the medicine may be an option. 

If you do stop it, be sure to do so with your doctor’s knowledge, so that together you can monitor your bone density over time.  Remember to keep exercising, getting adequate calcium and vitamin D, and stay away from the cigarettes and too much alcohol.  These steps can also keep your bones strong.