---------- Forwarded message ----------
From: denvernaturopathic
Date: Mon, Feb 8, 2010 at 1:00 PM
Subject: Fosamax needs a break
To: drjeannd@gmail.com

Fosamax Needs a Break: Don’t use this drug for more than five years
Jacob Schor, ND, FABNO
February 2009

The drugs that have been used with apparent success to treat
osteoporosis may now be a problem.  Alendronate may weaken bone and
lead to increased fracture risk.

[a referenced version of this article is posted at:
http://denvernaturopathic.com/fosamaxBreak.htm]

Alendronate is the drug we know as Fosamax.  It belongs to a class of
drugs called  Bisphosphonates.  These chemicals were developed in the
19th century but were not  investigated until the 1960s for use in
disorders of bone metabolism. Their non-medical use was to soften
water in irrigation systems used in orange groves. The rationale for
giving them to people is that they prevent the dissolution of
hydroxylapatite, the principal bone mineral, so stopping bone loss.
Only in the 1990s was their actual mechanism of action explained when
Merck brought Fosamax to the market place.

There is little doubt that these drugs do what they are supposed to
over the short term: they increase bone density and decrease fracture
risk.

The FOSIT study published in 1999 told us this quite clearly. This
study reported on 1,908  healthy, postmenopausal women with
osteoporosis, 950 of whom  took either 10 mg of Fosamax for a year,
while the other 958 got a placebo.  Both groups took 500 mg of calcium
per day.  After a year, bone mineral density increased by almost 5% on
average in those taking the Fosamax compared to the placebo group.
Non-spinal fractures decreased. Of those taking the drug only 19
suffered fractures compared to 37 of those taking placebo.

From the first use of these drugs, there was always a theoretical
worry.  Recall that there are two main processes that occur constantly
in the bone: osteoclastic activity that breaks down old bone, and
osteoblastic activity that builds up new bone.  This constant turnover
of bone maintains healthy and strong bone.  These drugs stop the
osteoclastic activity so that the old bone is left untouched.  This
increases bone density measurements.  The worry was that because these
drugs halt normal bone turnover people using them would end up with
dense but more brittle bones.  As the early studies consistently
showed a rapid reduction in fracture rates, this concern faded.

These early worries unfortunately were not  just a product of
naturopathic paranoia; the problems just took a few years to show up.
The May/June 2008 issue of The Journal of Orthopaedic Trauma published
a report on “Low-energy femoral shaft fractures associated with
alendronate use.”  The authors reviewed records of 70 patients who had
sustained low energy femur fractures.  That means their femurs broke
without any major stress.  Rather they did little things such as
walking or stepped off a curb and thus triggered the breaks.  These
weren’t young people, their average age was about 75.  Of these 70
patients, 25 of them, a little over a third  (36%), were taking
Fosamax.  Nineteen (76%) of those 25 patients demonstrated a simple,
transverse fracture with a unicortical beak in an area of cortical
hypertrophy.  This is a rare and peculiar type of fracture.  Only 1
patient of those not taking Fossamax (2%) had this kind of bone break.
 When the statistics were worked out, the numbers tell us that Fosamax
use significantly increased risk of these fractures: the odds ratio
was 139.33, 95% CI [19.0-939.4], P 0.0001).   You can say those taking Fosamax were about 140 times more
likely to get one of these rare fractures.  It took about 7 years for
this problem to occur.  Those taking Fosamax less than 2.5 years were
not at greater risk.

 A 2009 paper in Geriatrics continued this story.  It tells us that,
“The fractures are often preceded by pain in the affected thigh…” this
paper suggests that patients not take Fosamax for longer than five
years.    Another 2009 article, this one in Clinical Calcium, echoed
this warning and suggested that, “… alendronate treatment might be
stopped for a while after 5 years to prevent [these kinds of]…
fractures.”

Take a break to prevent a break might become a safety slogan.

Researcher from Johns Hopkins repeated this same story in the journal
Orthopedics in August 2009.     Then just last November, 2009, doctors
from New York University report on seven different patients who had
broken both legs. The average age of these patients was 61 years and
on average they had taken Fosmax for 8.6 years.  One patient had
broken both legs simultaneously. The article suggests  that we start
checking the ‘good leg’ when people who have been taking Fosamax
sustain a suspicious fracture.  If a problem is seen, they suggest
prophylactic repair.

Few doctors and fewer patients are paying attention to duration of
Fosamax use.  Most patients will report they’ve taken Fosamax, “for
awhile.”  We need to start spreading the message, “for awhile” should
be less than five years.
In our practice we are suggesting a break from use after a shorter
period of time, about three years.  Discontinuing Fosamax use and
relying solely on naturopathic treatments even for an interval of
time, may, in the long run prove to be a safer course of action.

Unfortunately over the years as Fosamax was used with apparent benefit
by so many people, many of us grew lax, thinking that our early
worries were unfounded.  In hindsight this may have been a problem all
along.  It’s only in the last few years that enough patients have
taken the drug long enough that we can actually see the results of
long term bone suppression.

................................................................

We hope you find the information in these newsletters useful,
informative and hopefully entertaining. If you want your name removed
simply leave a message at the office (303-337-4884) or go to the
website: denvernaturopathic.com and unsubscribe, or reply with the
message "REMOVE" in the subject line.  If on the other hand you want
to be added to the mailing list follow the prior instructions but
subscribe.
We are  posting most of these newsletters in our 'NEWS' section of the
website.  The website versions contain more complete references and
often abstracts of the references quoted and links to the full text of
many of the journal articles mentioned. You don't have to be a patient
to sign up and we encourage you to get your friends on our mailing
list so you don't have to keep forwarding the newsletters that you
find interesting.