FDA Review Advises Caution In Using Bone-Building Drugs.

I can't get any of those links to work.  Here's the New England Journal of Medicine link, if it works.

Bisphosphonates for Osteoporosis - Where Do We Go from Here?

Maybe now I get why after 2 years of Zometa I had three vertebrae fracture over a period of three months. How frustrating and scary.

Chickadee... That must be awfully painful. I am recovering from a broken foot...I can only imagine!!

Kitty is right, that is exactly how my endocrinologist described it.  The original bone is built on amazing strut systems, the bios can't build that type of complex bone.

I am currently on Fosamax for my spine osteoporosis.  I dunno what to say, I'm pretty sure these drugs are bunk, but I don't want to be on Prolia in two years if it keeps going like this.  I've added 500 mg of calcium, but it constipates me so badly that I have to take a lot of magnesium to counteract it, and that is supposed to be problematic.  

I go to the gym, try to eat better, and take the bios for a couple of years, 'tis all I can do for now...

Here is what Dr. Abramson has to say in Chapter 13 of Overdosed America....Notice there are TWO types of bone....Notice which type the biophosphate drugs target AND how:

 In 1995, Fosamax, the brand name for alendronate, was the first of the new generation of drugs approved by the FDA for the treatment of osteoporosis. Fosamax works by attaching itself to the surface of bone, interposed between the osteoclasts and the bone the osteoclasts are trying to absorb. Randomized clinical trials of Fosamax published in medical journals show dramatic reductions in the relative risk of hip fracture for women with osteoporosis. In a study published in JAMA in 1998, for example, women with an average age of 68 and a T score of - 2.5 or less who took Fosamax for four years were 56 percent less likely to suffer a hip fracture than women in the control group.

This sounds like very good news for women with osteoporosis, but how many hip fractures were really prevented? With no drug therapy at all, women with osteoporosis had a 99.5 percent chance of making it through each year without a hip fracture -- pretty good odds. With drug therapy, their odds improved to 99.8 percent. In other words, taking the drugs decreased their risk of hip fracture from 0.5 percent per year to 0.2 percent per year. This tiny decrease in absolute risk translates into the study's reported 56 percent reduction in relative risk. The bottom line is that 81 women with osteoporosis have to take Fosamax for 4.2 years, at a cost of more than $300,000, to prevent one hip fracture. (This benefit does not include a reduction of less serious fractures, including wrist and vertebral fractures. Most vertebral fractures cause no symptoms.)

[. . . ]

What about using these drugs to prevent osteoporosis? Fosamax and Actonel were approved by the FDA to treat women with osteopenia based on studies that showed that they significantly increase the bone density of these women. It is important to remember, however, that bone density is only a surrogate end point; the real reason for taking these drugs is to reduce fractures, and hip fractures in particular. The study of Fosamax published in JAMA in 1998 (mentioned earlier) also included women with osteopenia. Did Fosamax reduce their risk of fracture? The results show that the risk of hip fractures actually went up 84 percent with Fosamax treatment.* The risk of wrist fractures increased by about 50 percent (that figure may be statistically significant -- but this can't be determined from the data as presented in the article).

How can it be that drugs approved for the prevention and treatment of osteoporosis succeed in increasing bone density but have such limited impact on reducing hip fractures? The answer can only inspire awe at Mother Nature's elegance. There are two types of bone. Eighty percent of the body's bone is made up of the hard and dense outer layer called cortical bone. In some areas of the body, bones also have an internal structure of trabecular bone, which works like an organic three-dimensional geodesic dome, providing additional strength in the areas of the skeleton most vulnerable to fracture, such as the hips, wrists, and spine.

The lacelike structure of trabecular bone creates a much greater surface area than the densely packed cortical bone and therefore allows the former to be more metabolically active when the body needs calcium. Its greater metabolic activity also makes trabecular bone more vulnerable than cortical bone to the changed balance between osteoclast and osteoblast activity. As a result, when bone mass starts to decline in women, trabecular bone is lost more quickly than is cortical bone. Once the architecture of these internal struts is lost, there is no structure left onto which calcium can be added. (See Figure 13-1.) The new bone, formed as a result of taking the osteoporosis drugs, is then formed primarily on the outer part of the bone, the cortical bone. This increases the score on the bone density test but does not necessarily contribute proportionately to fracture resistance."

LtotheK....Where does it leave us osteo-challenged ladies, including me who is presently recovering from a broken foot.....hmmmm....I'm not sure!   I think though, that Dr. Abramson nails it when he talks about the beauty of Mother Nature.  There aren't many things that man can artificially create that can rise to the level of Mother Nature.  If you read the entire chapter in his book, you will then be able to appreciate what he's talking about.  Bone density machines pretty much measure the outer part of bone.  The bone density meds, coat the outer bone  (white washing) which according to Dr. Abramson, "...increases the score on the bone density test but does not necessarily contribute proportionately to fracture resistance." 

Thank you all who posted with such clarifying explanations!

I have osteopenia, and several years ago, my PCP wanted me on Fosamax. After reviewing the side effects, I absolutely refused. I concentrated instead on taking in plenty of calcium, in the way of both food and supplements.

After my BC dx, I had another bone scan. It was pretty much the same as it was several years ago - in other words, I hadn't lost any more bone density, nor had I progressed to osteoporosis.

In the fall, I'll start Arimidex. My MO mentioned that she might also put me on one of those "bone building" drugs, and now I am even more determined to say no.

I will instead concentrate on better nutrition, supplements, and now that I'm losing weight, increased and more regular weight-bearing exercises.

VR ~ I asked my MO about taking Zometa for recurrence...and he said the current studies are conflicting.  Have you seen that?

Interesting.  I will revisit with my dr.  I seem to recall that because I am pre-meno, it wasn't proven to be of benefit to me.  I will do some more research, thanks.

Okay.. that's what I thought I remembered.  I was 43 at diagnosis..45 now...and very pre-meno.  I guess I'll just stick with weight bearing exercise and calcium.

My endocrinologist used the FRAX tool (google it) to ascertain whether I should take bisphosphonates or not. Although I have osteoporosis of the spine (T -2.5) and less so at the hip (T -1.9),the advice was NOT to treat.My chances of a fracture in the next 10 years is estimated to be very low.

The endo said that the long-term side effects of bisphosphonates are not nice and that for a post menopausal woman,taking calcium supplements can also be problematic as there is research suggesting increased likelihood of atherosclerosis for post menopausal women. It is better to get your calcium form the diet.

To the "stay ahead of the problem" recommendation, that would make sense if these drugs worked.  But it seems clearer and clearer based on the research they do not build bone with integrity.  This information has become even more widely available in the two years since my diagnosis.

Wow, this is really interesting. I have broken my hip (a few months after starting Fosamax) and I also had 3 fractured vertebrae last year.  Then, recently, I had jaw pain. So I quit Fosamax a few months ago even though I have severe osteoporosis. Taking calcium citrate with D and jogging daily.

Susan'sgarden....the side effects range from osteonecrosis of the jaw, to esophageal cancer (with oral bisphosphonates, esp Fosamax), and spontaneous fractures of the femur.

I also know of several people who had to stop Fosamax because of severe ulceration in the throat.

Over the 3 years I took Fosamax, my bone density declined from osteopenia to osteoporosis - however, this may well have been due in part to undiagnosed hyperparathyroid disease, which was surgically corrected 2 years ago. (Hyperparathyroidism and breast cancer seem to be correlated in some way).