Bone Loss Drugs: Good, Bad or Ugly?

Photo courtesy of flickr user asjaboros / CC BY 2.0

I cringe at the television every time I see Sally Field talking about Boniva. Now, don’t get me wrong, I like Sally Field, I really like her. I don’t like her hawking Boniva, a long-acting oral bisphosphonate (a drug to prevent bone loss), similar to Fosamax and Actonel. I feel like we are being sold a bill of goods. And even though I refused to take Boniva when my gynecologist wanted to prescribe it because I have some bone loss, I always wondered if I might be doing myself a disservice.

Until now.  This week, two studies presented at the American Academy of Orthopaedic Surgeons’ annual meeting suggest the drugs might adversely affect bone quality and increase risk of atypical fractures of the femur, or the main bone in the thigh, when used for four or more years.

Now that the media is jumping on the bandwagon, there are several reports of women breaking their femurs without falling–just from walking up the stairs and such.

Add this to the long-term fears about these drugs and heart disease, and another side effect for which there is an ongoing class action suit–osteonecrosis of the jaw, in which the jaw bone decays, becomes exposed and in advanced cases completely deteriorates–and you have what looks like it could be the next hormone debacle.

There is a lack of convincing data that shows long-term protection against breaks for women who take these drugs in their 50s for osteopenia (a precursor to osteoporosis). It is when women get older, into their 80s, that the drugs seem to work best. Women can lower their bone risks with healthy habits alone, by eating a healthy diet, doing weight-bearing exercise and not smoking or drinking too much–all things that I’ve adopted.

As a health journalist, I am well aware of the many “wonder” drugs-gone-awry that were marketed, usually, to women–D.E.S, female hormones (before the Women’s Health Initiative), weight-loss drug Fen-Phen–and I am just not willing to take a chance. The profit motive of the pharmaceutical companies certainly comes before the health of the public much of the time, especially when it involves women.

But, that is not to say that all women on these medications should stop taking them. The Food and Drug Administration has reiterated that they are safe, although they do say that they are “working closely with outside experts … to gather additional information that may provide more insight into this issue” (sounds like the verdict is still out), so doctors will probably not be changing their prescribing practices any time soon. Says Dane Shipp, M.D., FACOG, an ob-gyn in private practice near San Diego,

My advice is to focus on this hard evidence (no pun intended!) and wait and see what happens.  If we jump the gun, a lot of patients will suffer because they will have spine/hip fractures that could have been prevented.  Their quality of life is improved by using a bisphosphonate despite the risk of atypical fractures.  In conclusion, my advice is that every treatment has risks.  Only the patient and physician together can evaluate whether the benefits outweigh the risk for the individual.”

Stay tuned.

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Mary Jane Horton has been a writer/editor for 30 years. She began her career contributing to jewelry industry publications, such as Executive Jeweler and National Jeweler, while still earning her journalism degree at New York University. After college she started writing in the burgeoning health and fitness field for such magazine as Fit, Runner’s World and Slimmer. She traveled the world for a few years writing for Fodor’s guides, Meeting and Conventions, Travel Agent, Successful Meetings, Diversion and other publications. She was a stringer for Time magazine for several years and has written for Ms., Shape, Prevention, Living Fit, Woman’s Day special interest publications, Vegetarian Times and many other publications. In the early mid-90s, after having 2 children, she found her true calling at Fit Pregnancy magazine. First as associate editor and then as articles editor, she became passionate about giving women the best start possible – physically and emotionally – for the most important job of their lives. Now she is editor in chief of Plum magazine, a health and lifestyle magazine for women over 35.