My father’s ulna was broken, in an incident that could hardly be classified as a fall, while he was taking Fosamax (alendronate). It’s a drug that should not be taken for more than a few years, and isn’t known to be beneficial for people in their late 80s, like him, but he’s still on it, and has been since 2013. So is my mother. He was on 7 drugs until recently.
It was a shock to me that his doctor could be so drug-happy. My parents had no health problems, just markers of the possibility of health problems. Both were so heavily treated for hypertension that they were disabled by falls (and consequent forced bedrest) their otherwise excellent health habits and daily, rain-or-shine, 1-mile walks wouldn’t normally have allowed. The way they were treated in hospitals worsened their health losses.
Check your parents’ drugs. Don’t assume they or their doctors have weighed benefits against harms. If they end up in a hospital, go to the hospital and see that they are allowed to leave if there’s nothing wrong with them. Keeping elderly patients in 3-day observation stays is a racket. Those 3 days on forced bedrest can be the beginning of the end of health. And if they insist on their right to leave they might be restrained and injected with haloperidol. That destroyed my innocent mother. (Things that are illegal in nursing homes are perfectly legal in hospitals.)
How could my dad stand, on acebutolol, Ativan, codeine, Fosamax, pravastatin, tamsulosin, amlopidine and finasteride?
7
Best Health Herbal Centre osteoporosis herbal remedy is not a joke, is real. My mother had severe osteoporosis for 10 years. 5 of which she was on medication. In the past 2 years, she have had 7 fx ribs, and it was revealed on x ray that she have a t-6 compressed disc. Luckily for me i saw many discussions in a group, discussing how they reversed osteoporosis with osteoporosis herbal remedy ordered online from Best Health Herbal Centre. I was Very shocked to see that, but i don't hesitate to order for my mother. My mother osteoporosis was total reversed after one month of usage. Her bone density in now normal..
1
Analysis paralysis for consumers on this topic. However, weight lifting, yoga, estrogen for women, higher levels of D, alkaline diet, and only some external calcium supplements work and are evidenced based-and makes no profit for Big Pharma/prescribers AND no side effects! More effort, yes. As we age, we deteriorate-fact of life! But crumbling is not an option for me. Get out there and enjoy the sun, wind and bone making! MOVE! It's true-you don't use it, you lose it!
5
Never once do you mention the dimunition in day in/day out quality of life experienced by people taking these drugs. 'Side effects' are just plain old effects. People choose not to take this nastiness because it makes them feel horrible. Tell the truth.
8
And do yoga! Yoga is a great weight-bearing activity that helps improve posture, balance and bone density.
4
In my senior exercise class of 25, 2 women have had osteonecrosis taking biophosphates and the third had lockjaw after her first use. The stats are clearly miscues in Dr. Lewieckis own back yard. If our insurance carriers allowed the newer treatments, we would not be so afraid to take the drugs but the biophosphates absolutely not. Yes, I am losing bone mass but I am afraid and so are my female physicians of the side effects. Seniors talk to one another and we are more informed than our "specialists".
7
A striking absence here is the recommendation of balance training and exercise: “advice is three-pronged: ‘medication when appropriate, an adequate intake of calcium and vitamin D, and don’t fall.’ ” It’s disappointing that the advice offered sounds like a cross-your-fingers-and-hope-for-the-best response, when research has shown that improvements in balance, reflexes, strength and posture can prevent falls. Furthermore, research has shown that the FEAR of falling leads to more falls, so telling people “don’t fall” only provokes further anxiety and potentially does more damage.
We hope medical leaders will publicly advocate fall prevention with more guidance and empower people in doing so. Our pilot study last year with Hartford Hospital's Bone and Joint Institute looked at balance and confidence levels with an older population, and while we’re still awaiting the data, the feedback was overwhelmingly encouraging. We believe it’s our responsibility as health and wellness professionals to help reduce fear and improve self-efficacy.
Rebekah Rotstein
Buff Bones®
6
Reading this article disappointed me deeply. I am concerned that both the author and the NY Times are passing on data provided by studies done for the explicit purpose of selling more drugs. In the abstract of the study, I found this paragraph problematic due to the nature of the study being of second-hand data and terms such as “projected” and “age-adjusted":
"Abstract
An analysis of United States (US) Medicare claims data from 2002 to 2015 for women aged ≥ 65 years found that age-adjusted hip fracture rates for 2013, 2014, and 2015 were higher than projected, resulting in an estimated increase of more than 11,000 hip fractures."
If the rate of fractures went down in the population because of the exercise boom of the late 1970’s, 1980’s, and 1990’s, that is exactly the type of leveling you might expect to see in the data. The first thing doctors prescribe (for almost everyone) should be is bone-friendly diet, and for many women who were young in the 1970’s, those changes would include compensation for the starvation diets young women used at the time (coffee and gum or cigarettes). The second--and with the same or even more emphasis than the first--should be exercise that loads the bones--all the bones, and lengthens and strengthens the spine.
I am a Pilates teacher and runner. I have seen first-hand how bone resorption and rebuilding can correct bone problems when the muscles are properly engaged and place an appropriate load on that bone.
8
Didn’t I miss it? Not one mention of physical activity to prevent osteoporosis? P.S. Men are affected, too; and much more likely to die as a result of hip fracture. Weight-bearing physical activity BEFORE peak bone density (late 20s) is critical. But also important in adulthood and older years.
4
As a male, I was diagnosed with osteoporosis at 51 years old. My understanding is that treatment with bisphosphonates is the only last resort in remedy. If one takes it in the earlier years, treatment would be less effective when used at a later age. I am already at risk of falls due to demyelination of the spine which has impaired my balance and mobility. I look forward to this year's bone density test results.
3
At 77 my wife had a very hard fall bam! on an unexpected patch of ice at the mailbox. She hit so hard muscles in her bum were crushed and took months to recover.
No hip fracture.
She's a vegan (well some fish a couple times a week) fitness exercise and still runs 5K, classic weight bearing exercise.
She did get a couple fractures on the radius in her left wrist, healed very nicely with a plate. She doesn't get as much weight bearing exercise on her wrists.
Classic testimonial for weight bearing exercise just like nature intended, bone gets micro fractures, body clears out the broken pieces, and builds new stronger bone in that place.
Fosamax prevents the clearing out of broken pieces so new bone gets plastered on top of the pieces which is structurally weaker than what nature intended. Oh, bone density test shows more bone, a mix of broken pieces and new bone.
Article after article, book after book, good weight bearing exercise does increase bone density no drugs required. "Strength and Power Training for All Agges" A Harvard Medical School Special Health Report.
14
Fosomax is more complicated than noted. Power training seems to be more benficial without side effects. Although I take lots of medicine I am sensitive to side effects which can be worse than the condition.
2
"Phytate may play an important role in the prevention of bone mineral density loss"
2
An extensive look at studies on bone health was mentioned in a prior comment and is well worth examining. "Osteoporosis: the emperor has no clothes" (Journal of Internal Medicine, 2015) surveys approximately 100 studies and demonstrates that current osteoporosis treatment guidelines are flawed.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4497616/
The report groups problems with current recommendations in regard to:
pathophysiology ("Most fracture patients have fallen, but actually do not have osteoporosis"/evidence does not support the notion that fractures cause excess mortality);
screening (limitations of using bone mass density to determine bone fragility, and to predict individual risk); and
treatment (“osteoporosis guidelines systematically ignore the obvious ‘evidence void’ in the RCTs [randomized clinical trials]”; “bone-targeted pharmacotherapy has, at best, minimal effect on the incidence of fractures and on fracture-related mortality and is associated with adverse effects”)
9
It's really not worth reading Jane Brody's columns since one can find the same point of view in the barrage of Big Pharma marketing to which we are subjected. I've nothing against bone density scans (I've had two so far), but if the rationale for them is to get more women on Fosamax etc., much of the research seems to indicate that the outcome would be not only harmful, but difficult to reverse.
Better to follow the advice of Dr. Loren Fishman (featured by the Times in 2013 in a series of articles addressing reader concerns about aging): http://www.nytimes.com/2013/05/08/booming/advice-on-practicing-yoga-in-m...
6
Not true to get more benefits on medication. My calcium and D aid to maintain my bone density although I have many muscular skeletal issues.
1
I took Forteo for 2 years which led to bone mass increase and changed reading on Bone Scan from Osteoporosis to Osteopenia. After that I refused bisphosphonates or any type of infusion. My Doctor was not happy about it, I agreed only to taking Raloxifene(Evista)which is a selective estrogen receptor modulator. After one year my DEXA showed improvement again- much to my Doctor's surprise. I also run 2 miles everyday and use light free weights at home and occasionally do Yoga. I also work on balance, and watch where I am walking in order to prevent falls. I was disturbed by Jane Brody's article- and felt she was simply writing for the drug companies, not sharing a true overall picture.
10
As stated in other posts, the half life of these drugs are 7-10 years or in that range. So if you start taking them you and have a problem the drugs don’t leave your body. I won’t even take a 12 hour cold pill so why would I take something that won’t leave my body for years. My dentists (endodontist, general dentist and periodontist) all tell me not to take them with my dental problems. They need to do more research and not just rest on their laurels.
3
Before receiving a dental implant, the first question my oral surgeon asked was, are you taking a bisphosphonate? In his practice he is coming across women with jaw necrosis who are on these drugs.
Ms Brody, you might want to look into this before encouraging women to hop on the Fosamax bandwagon.
7
Osteoporosis runs in my family, and my 80-year old father is a mess because of it. He is recovering from a burst vertebrae acquired by moving wrought iron patio furniture (shifting it around on the deck). He did not fall. He now has a ten-inch rod and multiple screws in his back and has undergone months of enforced rest, a clamshell brace, and physical therapy. His surgeon said his bones are like swiss cheese. One of my brothers and my sister also have this wretched condition.
Dad took Fosamax for years.
12
I have been asking every clinician I see and have searched Pub Med for years, in search of the clinical proof of bone density increases (or in the least, a halting of the process that results in bone loss). My search comes up empty. And not one clinician has been able to find me a journal publication demonstrating density improvement.
Additionally, I have found it difficult to find information on how broken bones are being tracked. One falls on the tennis court while running down a ball and trip on the tape, and takes a flying leap Using the hand to break the fall, the wrist fractures. Does this then become logged as a risk?
The medical profession wonders why we are skeptical? Give me answers to my questions.
4
What I learned from reading on the National Osteoporosis Foundation's website is that this wrist fracture is not an indication of osteoporosis. It was caused by trauma while fragility fractures are the indication of osteoporosis.
1
We have become a dollars and cents society. So many health articles refer to the cost, no matter what the topic, to support a point of view.
2
I started taking Fosamax about fifteen years ago when it was new, trendy and expensive.....sort of proactively after discussion with my doctor. I have slender build and frame and densitometer revealed osteopenia. The drug helped and my density numbers went up. Was on it for a few years. Then the reports came out about femur fractures in users and the scary stories of jaw bone necrosis. The drug inhibits osteoclasts. Normal bone function is not a static process. It requires both osteoclasts which break down bone and osteoblasts which rebuild bone. These processes are meant to go on all the time. I was worried when I needed a tooth extraction. Moreover, when I checked the drug info sheet that came with the med from Merck, they did NOT disclose the possible jaw bone necrosis at that time. The takeaway for me is that while widespread use for many is prob not indicated and that there was way too much pushy marketing for Fosamax, the drug is also not a pariah and should be used where indicated. Women def should get bone density when approaching menopause and every two years thereafter and take meds when needed. Broken hips are not a good thing.
2
Estrogen in multiple trials decreases the incidence of fracture in post-menopausal by 30-50%. In the Women's Health Initiative, with an ADVERSE selection of participants (age 63 versus onset of perimenopause) and bad selection of drugs, fractures were reduced by 33% and NO INCREASED MORTALITY after 18 years of monitoring. Biphosphates are similarly effective in studies, but in practice less effective in practice as your article points out. The increasing rate of osteoporotic fracture is related to estrogen cessation after publication of the WHI. Ref:and the original findings increased heart disease were revised to DECREASED heart disease. Prevention and treatment of postmenopausal osteoporosis
J Christopher Gallagher, MD
9
I'm a good example of the problem caused by the WHI study. I used HRT from the age 50 to age 65 with no problems. Then the scare reports after the study caused me to stop. This left me open to the serious side effects (hip and pelvis fractures among others) that happened after I had 2 injections of Prolia (which I reported on an earlier post).
1
I quit taking Fosamax because my dentists freaked out. One refused to do a root canal and another took extreme caution in performing my two implants. I am always asked by a new dentist if I have ever taken Fosamax. Who would continue taking it? I'm tired of prescription medications thatyou find out later have serious side effects.
12
Major insurance companies like Cigna don’t cover bone-density tests until age 60. I am a perfect candidate for bone-density issues but have to wait more than 6 more years to check it.
2
Depending on your financial situation, you might not have to wait. You can always chose to do something that's not covered by insurance, you just have to pay for it yourself. You do need an Rx from a doctor for a dxa scan because it is a low dose of radiation, but the cost of the exam in the Washington DC area is about $230 if the procedure is not covered by insurance. If that's not out of the question for you, call an imaging center and ask for the price without insurance coverage.
4
I have osteoporosis, according to a bone scan I had done about 8 years ago. My gyno tried to prescribe medication, which I refused due to side effects. I work out instead, on a step , with pylometrics, 4 times weekly for 40 minutes, also using weights. I am fit, trim and strong. I take vitamins and eat healthy. I gave up skiing and do not engage in activities that could risk a fall. At 67, I take no medications and continue to lead an active life.
14
As someone that developed drug induced Jaw osteonecrosis all I can say is stay away from these drugs. I was lucky to be treated by the leading jaw specialist in this Dr Robbert Marx - the awful side effects are more prevalent than reported. AND drugs lime Prolia have a half life of 11 years and remain in your system - in essence they had be overdosing me - a very profitable business - take calcium. Do weight bearing exercises and eat right. Most women with osteopenia need no more than that. There is nothing more frightening than finding a sliver of your jaw bone protruding in your mouth. I have healed and caught this early. But others not so lucky.
11
Fall prevention has not been discussed in detail here. Many falls are due to tripping hazards, that can be minimized by taking certain precautions. It may seem obvious that you should look where you are going, but many of us fail to do so in the best way. Central vision is much sharper than peripheral vision. When walking, look at the ground about 8 feet ahead of you, to better detect uneven pavement, steps or other surface irregularities that may cause you to trip. Looking at the horizon means that your are using your peripheral vision to detect tripping hazards, and peripheral vision is much less sharp than central vision. If your objective is sight-seeing, stop to look around and take pictures. Eliminate tripping hazards at home by removing scattered shoes and boxes from the floor. Don't walk and read a smartphone at the same time. Use hand rails, where available. and consider installing them on stairways at home, if they are not already in place. If you are carrying an object on the stairs, be sure to position it to one side, so you can still see the steps ahead of you, especially when going downstairs. Taking these simple steps will avoid many falls, and the injuries, including fractures, that result from them.
10
The military has fairly high injury rates. If you look at the research, you see there are a significant % of young folks with early osteopenia/osteoporosis (Lappe) caused by pre-entry malnutrition and disuse atrophy.
The AF tested all recruits at entry in one test. 25% of women and 9% of men were iron anemic. Treating that reduced injuries and attrition by 50%.
If you look at the NHANES & USDA data, malnutrition is fairly common. Especially in folks eating a plant-based diet (Moran).
Dr. Heaney, MD, a vit D researcher, found osteoporosis could be reversed. Hint: adequate protein intake is essential.
Bones are a living protein-mineral matrix filled with fat. They makes critical product (Red Blood Cells for example). They respond to stress just like muscles.
If you want strong bones, you need BOTH adequate nutrients (20 nutrients, not just one)(do a comp blood chemistry) and weight-bearing-impact exercise. Look at the extensive NASA research.
True, many folks won't/don't eat a good diet and don't (or can't) exercise. If you want to be healthy, do an annual comp blood chemistry (you can buy online) and exercise (weighted walking, lifting weights, etc.). I look forward to the NYT health writers leading by example and printing their results.
DEXA is not predictive. pQCT is the gold standard (Evans).
Drugs may be necessary, but should be that last choice.
5
An earlier post suggested "Rethinking the Appraisal and Approval of Drugs for Fracture Prevention". www.ncbi.nlm.nih.gov/pmc/articles/PMC5430022
It is quite interesting.
8
I much appreciate this reference. It is one I had not seen before, but adds further to my skepticism regarding the way osteoporosis is being defined, identified, and treated.
3
Thank you to Lallie for this informative article. Just what I was looking for; real clinical data about osteoporosis medications and their true effect on fractures. The data does not support reduction in hip fractures. Interesting how the numbers to define spinal fracture were "adjusted". There is a misconception that just increasing the bone density number will protect from fractures. As a 68 year old with severe osteoporosis I am choosing to improve my muscle strength and balance with training. Money well spent.
7
Bone density is not protective against fracture risk. Chinese women have lower bone density and less prevalence of hip fractures. Fosamax does nothing to help prevent fractures.
7
Here are 3 good articles regarding recommendations for preventing and treating osteoporosis.
They include - explanation of bone structure, best types of exercise, foods, supplements, choice of medications, and other lifestyle recommendations.
- "Preventing Osteoporosis - Dr. Fuhrman - drfuhrman.com
- "Osteoporosis Drugs May Be Doing Our Bones More Harm Than Good" - drfrhrman.com
- "Osteoporosis - Dr. Weil- drweil.com
5
An excellent critical overview of the osteoporosis drugs is "Osteoporosis: The Emperor Has No Clothes," published by Jarvinen et al. in 2015. The language used by Brody throughout her piece, e.g., "should be treated," and the multitude of quotes by physicians pushing the drugs, with not a single viewpoint from either a dissenting physician or a patient who has suffered one of the allegedly "very rare" side effects, reflects badly on The NY Times, which ought not be proselytizing for drug treatment under the guise of objective journalism.
37
No way is my doctor getting me to take a "bone density" test on his antiquated piece of equipment. Because (a) I don't trust his machine (b) it's another doc revenue source, and (c) no way in H would I take any of your "bone building" drugs.
If you bothered to do your homework, far better, safer treatment is naturally-derived hormone replacement therapy, especially testosterone for men and for women, adequate Vitamin D levels, weight bearing exercise, and a diet rich in fruits and vegetables and low in processed foods.
Oh I forgot, that RX makes no money for Big Pharma or for doctors and is way tooo much trouble for the average lazy American slob over 50 to implement. Much better to guzzle expensive drugs with awful side effects.
25
I'm with you Leonora; "…we've learned a lot about how to treat and whom to treat…" says Dr. Lewiecki. Great. Two decades of trial and error with a big drug and you've "learned a lot." At whose expense? Personally, my preference is to eat well, practice weight bearing exercises, practice yoga and strength training. Of course that's not making big pharma and docs a bunch of money.
2
Brody, once an incisive health reporter, has become a shill for Big Pharma. She wrote a similar puff piece a couple of years ago that landed on the front page as "news." Her fervent admonitions about the alleged dangers of not taking the drugs depend on her uncritical acceptance of claims that debilitating side effects are "very rare." My own experience with side effects, from other types of blockbuster drugs, causes me to mistrust all "very rare" assertions. Years ago, for instance, I took Prozac, regarded at the time as a miracle drug. I suffered a debilitating effect, akathisia, which the prescribing doctor tried to dismiss as "anxiety," saying she'd "not heard of" the acute restlessness precipitated by this drug. Over time, akathisia became widely acknowledged as a common side-effect of Prozac.
Similarly, the atypical femoral fractures and osteonecrosis of the jaw that the medical profession is currently minimizing in relation to the osteo drugs are being documented increasingly, especially when the drugs are used for more than a few years. (Many patients are told they'll need the drugs for "lifetime.") Combined with the dubious efficacy of the drugs, the rationale for taking medications that remain in your system for up to ten years -- a half-life that may be unrivaled by that of other drugs -- weakens the case that doctors try and make for them. The fear tactics that I and others have encountered are reprehensible, yet they create great anxiety among patients.
32
The puff piece you mention was actually written by the science writer Gina Kolata. Jane Brody should have reviewed the (mostly negative) comments she received before writing this new piece.
10
"Don't fall", in my opinion, is the best advice, and the only one I will follow. I "had" osteopenia and took medication until I read about the side effects and the risk of saving one bone while damaging another. It's my bones, and I do not trust drug companies, nor the medical establishment.
22
I want to know more about bone density versus bone quality. Thin bones may be strong. It can depend on the bone architecture. Why isn’t that discussed more often?
18
I agree ! The two studies referenced below are very informative about bone density v bone quality.
When are the recommendations for treatment going to take into account the increasing number of studies looking at bone architecture and finding problems with treatment of osteoporosis with drugs now in use?
A 2017 study published in Nature has nuanced explanations of bone strength complexities. The authors' evaluation of bone strength found “reduced mechanical strength noted in the bone samples from the bisphosphonate-treated group” compared to group w/ fractures but no treatment.
https://www.nature.com/articles/srep43399
A 2009 study published in Clinical Cases in Mineral and Bone Metabolism looks at bone architecture, and notes that DXA scans cannot adequately assess bone strength. Exercise in older people, good for bone quality, can change the geometry of the bone and develop harder material at the bone periphery, enlarging the bone, but without changing the mass, which is “disregarded by DXA or, worse ... erroneously detected as reduction in BMD and bone strength.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811354/
9
Thank you for providing the links to these studies. While they are technical, they still provide conclusions that a layperson can understand and are very helpful.
1
Yes! Very interesting! I am an athletic woman in my late 60s. I have always done weight bearing and compressive activities. Much to my ignorant shock I was told that I have osteoporosis in arms and hips and osteopenia in spine. This was a shock and gave the lie to the exercise as preventive advice. This information on bone structure and strength makes sense and is important.
2
I have read many of the comments, but I have only seen one book recommended. Lani Simpson has a book "Dr. Lani's Non-Nonsense Bone Health Guide" that I suggest to others. I feel that she has a background that makes her information reliable. Also, the National Osteoporosis Foundation has a website called Inspire. Some people might find some of the postings there interesting although I didn't agree with everything when I followed the postings.
3
I have just finished a great book called The Whole-Body Approach to Osteoporosis, by Dr. Keith McCormick, DC. He developed osteoporosis in early middle age, and was fracturing. He took bisphosponates for a short time to stabilize his bones, then embarked on aggressively researching *causes* of osteoporosis, not just *symptoms*. The book describes a holistic approach to identifying and treating those causes, not just throwing pills at the symptoms. Lots of great info I am putting to work in my life and for managing my osteoporosis.
2
"At the same time, Medicare reimbursements for bone density tests were sharply reduced..."
The GOP can't destroy Medicare directly so it uses this stealth method. All prevention and all diseases are affected,
You find out when it's too late.
12
It seems to me that this article was paid by" Fosamax." It's really scary that we cannot trust anyone anymore, particularly, when having a system in which health is not a right but a profit.
11
Please NYT Again- by what amount is the risk reduced by taking these meds?
"Although bone-sparing medication has been shown to reduce the risk of a second hip fracture"
10
Sadly, it reads like a PR piece for the pharmaceuticals industry.
Must do better.
31
I'm appalled by this article by Jane Brody, a proponent of bisphosphonates. I was given Reclast injections by my rheumatologist, Dr. Charles Pritchard for 5 years. Although I never had a broken bone up to the age of 67. Then, in June, 2015 I broke my right femur. Five weeks later I spontaneously broke my left femur. Doctors have been sold a bill of goods by Big Pharma. Enough is Enough! NO person should be taking these poisons. Unfortunately, I will never be the selective person I was 3 years ago.
21
And not a word about estrogen replacement.
12
Exactly. That was my first thought as well - if we're going to talk about trade-offs and real life risk vs benefits of medication-- why not have a more honest discussion of HRT?
15
I have been taking Evista- my Endocrinologist was not happy that I would not go on a something else, or take an infusion- but I refused. MY bone density test after a year on Evista showed Osteoporosis in the hip went to Osteopenia, and other numbers improved too. And it protects against breast cancer.
2
I see that my comment which I posted early this morning hasn't been printed. Why? Did you think I wasn't telling the truth. I was. Did you not like the fact that I pointed out how careless and uncaring some doctors can be? The National Osteoporosis Foundation has a website called Inspire. You can read stories such as mine there. More and more women will refuse these drugs until a way is found to prevent these side effects.
14
For years, I have been warning patients, friends and family members about adverse effects of osteoporosis drugs. After years of foot-dragging, the FDA issued a warning on Oct 13, 2010 of “possible” risk of femur fractures caused by bisphosphonates. They also added a new warning label. The Task Force found that almost all women suffering from atypical fractures of the mid femur were on these drugs. This same ASBMR task force reported in 2007 these same drugs cause osteonecrosis of the jaw. When a drug adverse effect is identical to the underlying disease the drug is supposed to treat, we have the perfect storm. Osteoporosis drugs are marketed and sold as fracture preventive, and are not supposed to cause fractures. Yet they do. This is a very bad thing, and indicates a profound problem with the drug. Drug manufacturers use ghost-writers to manipulate data from clinical trials to make the drug look good, and clinicians can deny the obvious when patients come in with fractures while on the drug, blaming it on the osteoporosis, and not an adverse effect of the drug. Most educated patients and doctors have already abandoned the bisphosphonate drugs, and instead use preventive strategies and non-drug treatments. For more: http://jeffreydachmd.com/2015/03/fda-says-osteoporosis-drugs-cause-femur...
49
Thank you Dr. Dach.
I hope readers will
heed your advice.
Please Ms. Brody,
I hope you have
material for a
follow-up article.
5
At menopause I began using HRT as I had a history of broken bones. When the studies showed that could lead to breast cancer I discontinued. At the time I was 65 and Fosamax was being prescribed for fracture prevention. So I started Fosamax and use it for over 5 years until an article on the front page of the New York Times reported the cases of atypical femur fractures. About 6 months later I was lying in bed, and when I got up I had severe back pain. I never dreamed it could be a spinal fracture, but it was. Thinking I needed medical advice I went to a specialist. He started me on Forteo which I used without any problems for 2 years. That was just after Prolia was approved. So the specialist told me I needed to use this new drug which was so safe he'd let his mother use it. I had 2 injections and 3 months after the second I began having trouble walking. In November 2012 I couldn't walk, but the specialist didn't even order an x-ray. He gave me a third injection saying "things would be worse without Prolia". Finally, an MRI showed I'd sustained a fracture of my right hip and a pelvis fracture. If you want to know why women are refusing these drugs, this is the reason.
44
It is heartbreaking to read stories like this. All of this would be avoided if women were given hormone replacement at menopause. The early studies suggesting an increased risk of breast cancer were later shown to be wrong -- the association with cancer was mainly due to the use of the synthetic progestins that had been used for birth control -- but the bad rap against estrogen has persisted among practitioners despite it after all these years. Not only osteoporosis but dementia, heart disease, and even some cancers can be prevented with estrogen replacement. The conventional wisdom, once it becomes entrenched, takes forever to change -- the safe recommendation persists because of fears of malpractice -- but the research is overwhelming for anyone who wants to look it up.
6
I too was diagnosed with mild-to-moderate osteopenia--had my DEXAScan the same day I was about to start radiation for breast cancer. A month later I began taking a class of drugs called aromatase inhibitors (AIs), which drastically reduce estrogen to starve tumor cells. But estrogen deprivation causes bones to weaken, and my docs (onc., endocrinologist, FP) agreed "doing nothing was not an option." I have GERD so oral bisphosphonates were out; one infusion of Zometa, its I.V. form, was an ordeal for over a week. (My FP doesn't believe in bisphosphonates or any bone meds except for osteopenic breast cancer patients on an AI, and reluctantly at that).
I got Medicare approval for Prolia (a biologic). Two out of six shots into treatment, and no side effects yet...other than partial reversal of osteopenia, per my latest scan. I also take Calcium Citrate (better absorbed than carbonate for those on GERD drugs), Magnesium, D3, and K2, and I walk as much as I can. Had a minor injury (sprained wrist) but when it heals, I'll go back to rowing and weight/balance training. One more benefit of bone drugs, especially Prolia, is protection against bone metastases (and its higher-dose more frequent form Xgeva, is given to slow or stop the progression of bone mets).
2
Data set with one point:
In her mid-80s my mother fell and face planted on her bathroom scale. She broke her cheekbone near her eye. It healed well but she was on what we called a "no chew" diet for 8 weeks. Then she was prescribed Fosamex. I do not recall a bone density test. She tolerated the Fosamex reasonably well gastricly but a year or so on X-rays showed that she had developed painful bone spurs in her shoulder. There were no other changes in her lifestyle or meds in that period. The bone spurs were a very serious problem for someone who walked using a walker for weight bearing because of a neurological problem in one leg that haad worsened over decades.
10
Yes, bone spurs are a possible side effect. The National Osteoporosis Foundation has a website called Inspire. I have read of this side effect on their website.
9
Thank you Ms. Wetzig. I am going to look at the website.
5
Refusing to pay reasonable fees for bone density tests - if that is a major problem with Medicare - represents serious discrimination against women and the aging( men too) in general. Broken bones in this group would be seen as an epidemic if it were from infectious disease, rather than seen by the ignorant pols as a sign of aging. Broken hips- ignoring personal costs - cost the country a fortune. Prevention would be expensive, but in this case, worth the investment. It isn't, after all, as if anyone needs a density test every year. Or every two years.
The meds ARE scary -the osteopenia I developed in the 5 years post menopause hasn't yet forced me to choose ( now 15 years on). Over a likely long lifetime, that will arise later.
Ms Brody has to skip some related issues to focus the article on recognizing the immense impact of ignoring bone loss. One is the topic of estrogen replacement. Standard thinking now seems to be: it's ok for a limited period of time (except for women with or a proclivity for breast cancer). We still need more research about how to use it as a preventative, and in which cases it presents a danger. I followed the best use ideas when I hit menopause, using low dose hormone replacements for a few years. Now it looks as if it would have been reasonably safe to continue -but not to restart ( heart problems can be triggered or made worse).
All choices have up-and down-sides. But not knowing your risks leaves you with no choices.
5
Prescriptions have fallen off
because there is a concern
that these "bone building"
drugs are not effective,
are over-prescribed and are often
dangerous. Read a 2017 study,
ncbi.nlm.nih.gov. If this link
does not work, look up
the study entitled "Rethinking
the Appraisal and Approval of
Drugs" by the NIH. I was prescribed
bisphosphonates for 12 years for
osteopenia, a non-condition. For no
reason other than a terrible reaction
to these meds I had femur fractures
resulting in a surgical procedure.
It is a difficult surgery and recovery;
many do not adequately recover.
The statistics provided by the drug
companies are not correct. Femur
fractures and jaw issues are called "rare"
but their numbers are unknown.
It would be responsible for a
physician to have questions
when she/he sees that a patient
has been on bisphosphonates for more
than three years. Many
physicians are not aware of this issue
despite the fact that there have been
articles and seminars about the dangers. I
would urge women to research these
medications and to consult with an endocrinologist,
rheumatologist or bone expert before
taking them. Ms. Brody, I respect your
knowledge and would urge you to
follow up with dissenting opinions.
Thank you.
22
I have found physicians and endocrinolgists play down the side effects of these drugs. Everyone should read the article you mention and not imagine the drugs available are "miracle" drugs. Thank you Karen.
16
I assume this article was in some way sponsored by the pharmaceutical industry.
So called 'bone sparing' medication have very poor side effect profiles, tend to be very expensive, and the evidence for their benefit is scant indeed.
Taking a vitamin D supplement and a walk every day is better than any anti-osteoporotic drug and has almost no adverse side effects
29
A fracture is often the first indication that a patient has osteopenia or osteoporosis. The interesting side note I learned years ago is that falls do not necessarily cause the breaks - sometimes (particularly with hips) the break causes the fall. My mother and two sisters both have osteopenia/porosis - with one sister having early onset for genetic reasons. But for some reason, I've managed to keep my bones strong in my mid-50s...however, this article reminds me that I should focus on doing more weight bearing exercise - other than bearing my own weight.
10
I broke the greater trocanter of my left femur in 2 places, nicely illustrated in the accompanying article illustration. Fortunately I healed in 3 months. In the meantime, my pcp started me on vitamins. D, Folic acid and a few others. She, not only being a pcp, has a specialty in weight management---After taking almost all the blood in my skinny little body, I was discovered to have been rather malnourished (for a variety of reasons) and underweight. 63 y/0 5'10 118 lbs at the time. The vitamins have changed my life. I am eating more, my digestive issues have calmed down, and the next bone scan will tell. The vitamins made a huge difference. Have all your levels checked. Hope this is of help to someone.
16
There is NO evidence that vitamins will enhance bone growth for the average women. NONE. But if you are deficient, their absence can cause problems.
Your overall health does of course matter immensely, as an undernourished body is struggling just to survive, and healing injuries requires added nourishment, so your doctor is definitely on the right track. The process of bone building includes continuous destruction and building, so the need for good nutrition is constant.
For women with a long history of malnourishment, it may well be that the lack of bone development years and years in the past has set up a more fragile skeletal framework.
5
I totally concur that vitamins will not bring back my bones. I have osteopenia. I still say--have the blood drawn and check your levels. I recoil at having to take any of the fosamax et al drugs.
8
my Chinese partner resisted going for an annual checkup (fear of authority/bad news/cutting) - when she finally went the blood test showed high calcium
further tests found a faulty parathyroid gland (1 of 4 - two on each side of the throat - http://phoenixrising.me/wp-content/uploads/thyroid-parathyroid-diseases.... - we found the top surgeon for this tiger territory(risky as many nerves in the area) - got it removed
now she's fine and has removed her inherited risk of osteoporosis which I've read is a virtual death sentence after a fall when hip bones with osteoporosis are too weak to accept a hip replacement.
3
Why on earth should we trust any story that suggest the only solution to be...pharma drugs? What about simply getting enough calcium (plus Vitamin D, which helps the body and bones to properly ABSORB the calcium), combined with weight-bearing exercise (walking being one of the best, as the weight of your overall body then gives a workout to your spine, hips, etc.).
7
This article appears to be an advertisement.
18
Vitamin K2, Magnesium, Potassium, Vitamin D (or sunshine!). You probably don't need more calcium--it's in everything. Exercise, especially weight bearing and jumping. Get plenty of sleep.
If none of that works, think about drugs. But only as the last resort.
7
I've seen many comments below that talk about how to 'avoid' falls..the implication being that the falls themselves can then cause thin, brittle bones (i.e., the hipbones) to break.
This is a common misconception, fed by the often-uttered phrase of 'they fell and broke their hip...' In fact, it is typically the exact opposite....peoples' hip bones actually breaking on their own...due to stress, loss of density, etc. The break in the hip bone is what then causes the person to FALL.
So, indeed, while we should all try to avoid falls as we get older (install night lights in the home, always use staircase railings, walk carefully on snow and ice, remove slippery area rugs, etc.)....we also need to understand that part of that equation is ensuring our bones remain as healthy as possible. And this is accomplished with sufficient calcium, Vitamin D and weight-bearing exercise.
Having good balance can also help, should you either slip and/or your hip bone breaks on its own. Yoga, pilates (strengthens the core), Tai Chi, wobble boards... all of these things can help you better manage a slip or fall.
4
Of course there is truth in what you say about the cause of hip fractures, but the 5 women I know all had hip fractures caused by the fall. Usually they were in a hurry or slipped on the ice. Also, the only death I know after a hip fracture was my grandfather's who died because of poor care in the hospital not from the fracture itself.
2
Why is the direction of causality a common misconception ? The patient would certainly know which came first, the pain and weakness in the hip, or hitting the ground. Maybe one should ask the patient ?
2
the healers vs the profiteers. Let the healers have a come back.
12
I find this article heavy on generalizations and light on useful information. Too many doctors are still uninformed about the serious dangers of bisphosphonates. The drug industry promoted these drugs for prevention of osteoporosis and the result was a rise in osteonecrosis of the jaw and atypical femur fractures. That women are fearful of and refusing to take these drugs is a good sign that women are paying attention, but misinformation is still rampant. Many articles I see still say that the benefits outweigh the risks, but I would like to see reports on studies that distinguish between those who were prescribed the drugs for osteopenia who suffered AFFs, and those who truly had osteoporosis severe enough to require medical intervention or treatment and who did not suffer these terrible consequences.
Bone density tests do not reveal much about bones other than density, and that alone is not a measure of whether or not to take these drugs. My bone density showed mild "osteopenia" when I was prescribed Fosamax in 2005, yet 5 years later my right femur snapped like a toothpick when doing nothing more than getting up out of a chair. I still do not have osteoporosis and I have been off of this poison for 8 years. My bones were damaged by this awful stuff and all I can do now is try to offset the effects by making dietary changes, making sure my calcium and vitamin D3 levels are sufficient, doing weight-bearing exercise and hoping for the best.
None of this had to happen.
30
Your second paragraph should be required reading. I had a spinal fracture after over 5 years using Fosamax. I used to say the drug didn't prevent the fracture, but now I feel the drug probably caused the fracture.
6
This article does a wonderful job raising awareness of bone health, which seems to have been forgotten.
For me, bone health and orthopaedics were taught last in medical school, most patients never check their vitamin D level as diabetics do for A1C, and there are no mainstream societies for bone health (have you ever seen an “American Hip Fracture Association” logo on a box of cereal?).
Bone health affects everyone. After one’s late 20s and early 30s, the amount of bone diminishes with time. Fact of life. Happens to everyone, women more. Bone loss is near impossible to reverse, so the sooner one acts to preserve it, the better chance they have. We must stay informed and take charge to prevent the most catastrophic complication of weak bone – hip fractures which are common, costly, debilitating, and deadly.
Weak bone is a multi-faceted problem – age, genetics, sex, weight, activity, diet, other medical problems play a role. Unfortunately, there is NO silver bullet medication or diagnostic study.
In my orthopeadic hand surgery practice, I speak with every patient who has a fragility fracture about bone health and initiate the workup and treatment before sending them to a specialist in bone metabolism who can monitor and individualize their long-term surveillance and treatment. For me, it is a step in the right direction.
14
What about having everyone lift weights, which have no side effects except for lifting moods and improvung physique? Why does everything have to be cured with a pill?
24
The comments to this article are heartening. People are catching on. It's all about the money. Read about Merck and the history of Fosamax, if you're not convinced. The company set out to make "Osteopenia" a disease, to sell more product. Want folks to trust the medical profession? Eliminate the profit motive.
31
Thank you Samantha Kelly. It's a harrowing story and very easy to research. Anyone who's taking or considering taking Fosamax needs to make an informed decision.
9
Oh, I don't know. Osteoporosis was rife on both sides of my family, and I have it too. Not one of my relatives ever had a good time on Fosamax and so stopped it way before they were told too -- as I did, after about a month.
They didn't suffer from having done so. Only one aunt ever broke anything, and she was a bit of a lovable klutz -- the fall that broke her wrist was gargantuan. She went in her upper 80s from pancreatic cancer. Another aunt died in her mid-80s when she essentially went mad after both her adult children died of cancer in their fifties. My mother died of lung cancer at 75, with lousy but intact bones.
While I do not minimize the misery of breaking a hip . . . .
For the record, I've seen more middle schoolers on crutches and in slings than adult women with the porous bones which aging brings.
10
" . . . before they were told too -- as I did."
Sigh. Before they were told to, as I did too.
3
I too was prescribed Fosomax after a bone density scan revealed osteopenia in both hips over a decade ago at age 49. One dose, just one, taken exactly as directed, and I was off to the ER with chest pains, shortness of breath, and my jaw completely locked up. Fosomax is now flagged in my medical records. My dr at the time suggested I try another drug. I was not willing to risk it. He also insisted I take a high dosage calcium supplement. Aside from the side effect of severe constipation I had experienced, I read that these supplements had no proven results of building bone mass. Instead, I opted for seeking out more naturally absorbed calcium in my daily diet. I also got serious about doing weight bearing exercises. And I became religious about Pilates (on the mat) using my own body weight to build muscle and bone strength as well as improve my balance, core strength and flexibility. I still have scans every few years or so and they have shown that my condition has not progressed at all. I'm still in the normal range of osteopenia for a woman of my age and stature. (soon to be 60, 5'7", 110lbs)
16
Ms. Brody completely neglected mention of the MANY women who, like me, took Fosomax and would have stayed with it except for the very common side effect of acid reflux. For me it was intolerable -- routinely both painful and disruptive to sleep. I don't appreciate being lumped in with the fearful ninnies she describes.
16
I also have GERD and was in a study quite a few years ago to evaluate a quarterly infusion of Boniva. Since it is not taken by mouth and bypasses the digestive system, it was a godsend for me. When my DEXA score improved from osteoporosis to osteopenia four years ago, my doctor decided a “vacation” from Boniva was in order as long as my condition is stable. She does monitor my Vitamin D level and advised calcium supplements. I do yoga and weight training as well. Medicare covers my DEXA scan every two years.
2
Fearful ninnies or cautious skeptics? I'll err on the side of caution, lifting heavy weights, eating whole foods, and some Vitamin D, rather than trust Big Pharma.
16
Cancellous bone. Look it up.
Vitamin D very large doses, zinc modest dose and melatonin small dose are the answer. Forget bisphosphonates unless you are one of a tiny minority with dysfunctional bone.
Just MENTION the class of drugs to your dentist: I dare you.
3
Like me, a few thousand victims of "a very rare fracture of a femur" caused by use of the prescription drug FOSAMAX for "osteopenia" aggressively prescribed by Gynecologists without warning about extended use consequences until 2010 are waiting for compensation from Merk (Fosamax) and GenenTech (Boniva) who are dragging the process in a New Jersey court until all of us will be dead...
Khonkamon
Arlington, Texas
10
Poor balance, muscle weakness etc. cause many falls. These are a major factor in fractures. There is much hype and misunderstanding about osteoporosis and use of Fosamex is one of the biggest. The treatment of bone densities also an error. We now are learning much more about this problem and our older knowledge is in error and misleading. Many billions of dollars involved so difficult to change the approach.
For a complete review of all of this and the latest discoveries and suggestions for treatment and prevention see letswakeupfolks.blogspot.com-Lets talk osteoporosis.
1
If you can't keep the drugs down, it doesn't matter how good they are. I tried 3 different ones and my stomach did the same thing every time. Within 5 minutes of taking it, I was throwing up. When I mentioned this to my Dr., she said lots of women have that problem.
8
I have been told by two different doctors that bone density tests are only recommended now for women at age 65, unless there is a specific reason to suspect bone loss (like family history, or pain?) This surely means fewer women are being diagnosed and treated in a timely manner...it makes no sense! And Jane Brody does not mention it here.
1
With all due respect, I suggest that Jane Brody is not qualified to promote any medication for anything. Her column is entitled "personal health" and that is all she should write about.
11
Can anyone speak to the distinction between bone density/thickness and bone strength/health? Preferably with a reference or two. Thanks!
Does anyone else wonder if we are pathologizing normal aging?
5
SO - my mom has been in a wheel chair 8 1/2 years now due to a hip fracture because of severe osteoporosis., subsequent to post menopausal bone loss and a severe balance problem, etiology unknown. She is lucky that her spine hasn't collapsed; that leads to breathing problems.
I do not think that efforts to prevent such fates amounts to pathologizing aging.
Don't have a direct ref for the questions, but you can look for discussions of bone micro-architecture which is a more sophisticated indicator of fragility or strength - testing not available. If you review reports on alendronates, one concern about the type of bone that gets laid down is that it is/may be different - more brittle, with no flex.
Bone density is used as a synonym for strength, tho', and per research, has been a good indicator of fracture risk.
1
My mother tripped on her front stoop (in assisted living and widowed after she moved there) in her mid 80s, and broke her hip. She had surgery to repair it, and recovered so well (walking around and to town) that a year or two later she had surgery to remove metal hardware that were "bothering" her (her explanation was that she had less "padding.") She lived to be 93, where she died of something other than complications of a broken hip.
Most of us, as we age, lose bone density; it's like getting wrinkles ad gray hair. And I've read that bone density is a poor proxy for bone strength, both compressive and tensile. I think the better approach is a good diet -- lots of whole foods that are plant based -- and exercise.
1
"Bone density vs bone quality: What's a clinician to do?", by Licata, speaks to the topic you're wondering about.
1
This is not the first time the NYT has published an article about osteoporosis so obviously pushed ahead by the pharmaceutical companies. Enough is enough with the scare tactics! Notice there is no mention about why there would be such non-compliance with osteoporosis meds. I for one, took the advice of my doctor, agreed to a once-per-year wonder drug for osteoporosis reversal, and consequentially lost a year of my life to horrible side effects. I'll spare readers the gory details, but I am far from alone in my experience. Go into the online community, or ask around-- you'll hear the same story repeated over and over again about our current bone meds. This is insidious, NYT. You're being played, and in publishing this kind of "research", are playing your readers.
17
Yes, I had horrid side effects from Prolia but I read about women with even worse problems on the National Osteoporosis website called Inspire.
2
"I for one, took the advice of my doctor, agreed to a once-per-year wonder drug for osteoporosis reversal, and consequentially lost a year of my life to horrible side effects."
Well, you see, that's the problem. It's bad enough when you take a drug -- Levofloxacin comes to mind -- whose adverse side-effects can take a couple of months to subside; but when you take a once-yearly injection of something, what happens? There's no antidote. You have to live with the consequences.
My reaction to Fosomax was like my mother's and aunts', and so I stopped taking it. I took one Boniva and had odd sensations from it, and so I never took it again.
But you can't undo an injection that lasts a year.
5
Actually, these drugs stay in one's system for far longer than a year. They have a "half-life" (i.e., time in system) of up to TEN years -- the longest half-life that I'm aware of for any class of drug (though there could be others). This raises their side-effect risk significantly, as unlike with most other drugs, you can't count on symptoms resolving merely by discontinuing the drug.
1
As my parents got older, it seemed as if every phone call included news about a friend or relative who now had a broken hip. At 74, not one of my contemporaries has had this misfortune. Hmmm...
I was put on Fosomax for osteopenia when in my 50's. It exacerbated my GERD and I stopped taking it. I now have a diagnosis of osteoporosis, but have chosen not to take any meds for it. My doctors - all of them! - totally agree. My mother had osteoporosis and also Lupus, and took a lot of steroids, which should have put her at great risk for a fracture - she was also quite frail. No falls or breaks, but she had always been very active and had excellent balance and reflexes. My father was very overweight and fell constantly. Fortunately, he had terrible reflexes, so he never threw out an arm or leg to try to break his fall; he just went down like a bag of rice. No fractures, ever.
I take so many meds for my chronic pulmonary problems and my GERD, and tend to be the poster child for drug adverse reactions, that I would be very loath to take meds for my osteoporosis. I do resistance training 3 times weekly for my pulmonary problems. I have excellent balance and strong reflexes. I also am blessed with a good family history of no breaks.
I think that doctors and patients have been very wise to not jump on the bandwagon of such drugs for everyone. Each case needs to be decided individually.
7
Great advice - do whatever you can to preserve and enhance your muscles, reflexes, balance -- all of the other behaviors you can control without the meds. because if you don't exercise - taking the meds alone isn't going to preserve those other senses and strengths.
3
Some of us are having issues because it's our first serious experience with powerful drugs and with the medical industry/community. Having now decided on the least-worst option and committed to an injected anti-osteoporosis drug for at least six years, I am really shocked at the way my endocrinologist discounts side effects like esophageal irritation. When I describes this to my PCP, she said she was very familiar with this side effect: "funny how even the injectables irritate the stomach," she said. It is really hard to get treatment for side effects when they aren't acknowledged. I have had other issues with my health since taking first injection. I don't think that is coincidental, but the list of side effects for my particular drug is EXTREMELY short. One feels very isolated as one's health goes down (tangibly, as opposed to the less tangible effects of osteoporosis).
5
As a patient who experienced severe side effects from a biophosphate, I am amazed that you only mention femur fracture and osteonecrosis of the jaw. I ended up with stroke like symptoms and double vision for six months due to the drug being in my system. Do MDs realize that there are other side effects that can be debilitating to the patient? It took months for my doctor to finally admit, after extensive medical tests to determine the cause of my medical incident, that it was due to the yearly infusion I had prior to my episode.
I am not disputing the benefits of these drugs but I believe the incidence of side effects is under reported due to the fact that it is difficult to link symptoms to the drug and a doctor really has to want to link the symptoms to the medication in order to pursue it.
13
Do people in other developed countries take these "bone preserving" drugs? What is their corresponding rate of fracture? Are Americans more prone to bone density loss than other countries? Me thinks not. Its the sedentary lifestyle that "trips" up Americans. I live in the UK now and never see the NHS pushing drugs like this. It would be good to have some comparisons. After all, bones are bones anywhere you live.
17
A typical Jane Brody article: pro big pharma and mainstream medicine, and severely biased. No comments illustrating opposing viewpoints. I am 70 years old and was diagnosed with osteoporosis last year. After researching the drugs my internist suggested, I opted for walking, weight-bearing exercises, 500 mg of calcium and 1,000 mg of vitamin D a day. I am also taking every precaution against falling. In addition to the horrific side effects, there isn't even irrefutable proof these expensive drugs work! As has been mentioned, many other factors can be responsible for the changing demographics pertaining to fractures.
18
This article appears to be a pharmaceutical add to promote a drug that includes well known risks associated with long term use, including osteonecrosis of the jaw and atypical femur fractures. Health articles that promote weight bearing exercises, walking, and nutrition would be far more helpful to readers.
69
Sorry, I do all of that, yet when I fell I broke my pelvis. The doctors told me that I have the bones of a 75-80 year old while I'm only 65. If there is a medication that would help, I'd gladly take it.
3
I see your point but here is another view - my wife last year suffered several compression fractures of her spine resulting in a loss of 2" in height, chronic pain, a major change in our lifestyle, and a huge fear of another compression fracture, or worse, a fall that would result in a broken hip. Our plans for post-retirement travel evaporated since she can now not sit comfortably in an airline seat long enough to travel overseas.
My wife knew she was at risk and did all the things recommended to avoid osteoporosis - vitamin D, calcium, weight bearing exercises, hormone replacement therapy, etc. But still she ended up with sever osteoporosis. It has changed our lives and those at risk should look at all options to avoid it, including drugs when appropriate.
6
I hope you and your wife are able to handle auto trips in North America. My husband doesn’t fly at all but enjoys museums and historical sights and a bit of scenic hiking (no steep hills or difficult terrain). He says that he would consider traveling to Europe on the Queen Mary if we didn’t have pets that wouldn’t tolerate our prolonged absence.
1
A recent article in Frontiers of Pharmacology (May 2017), “Rethinking the Appraisal an Approval of Drugs for Fracture Prevention” reviews studies of drugs used for fracture prevention over the past 30 years and challenges the general belief that drug therapy is a solution. Bottom line: “After decades of widespread use, effectiveness of drugs for osteoporosis remains uncertain, yet adverse effects are more apparent.” The details are illuminating and convincing:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5430022/
Of particular note (on bisphosphonates) is Table 1, “Real-life evidence on the effectiveness of bone targeted pharmacology,” which summarizes study samples, design, findings, etc on 4 studies between 2009 and 2013 in high-end journals, which showed that hip fracture risk INCREASED in bisphosphonate users. The authors refer to a New England Journal of Medicine study which found:
“Despite their questionable harm-benefit ratio, bisphosphonates are still widely promoted and prescribed even after US FDA officers pointed out a possible increase in fracture risk in women receiving bisphosphonates.” (Whitaker et al., 2012)
53
xyz, that was an excellent, evidence-based response to Ms. Brody's article. I've saved the link to the study to show my endocrinologist, who has been pushing to at age 60 to start biophosphates when I only have average osteopenia for a female my age and have no history of fractures.
1
THANK YOU!! xyz. Thank for the link to a scientific publication in a peer reviewed journal ("Frontiers in Pharmacology is a leading journal in its field, publishing rigorously peer-reviewed research across disciplines, including basic and clinical pharmacology, medicinal chemistry, pharmacy and toxicology." https://www.frontiersin.org/journals/pharmacology)
I am going to print this article out to give to my doctors. Everybody should read it, and do the same.
But I wonder why Ms. Brody did not do her homework? I think that the quality of her work is going downhill.
3
As others have commented here, Brody has failed to mention (aside from "don't fall") any preventive measures such as weight-bearing exercise, improving balance, diet, and assessing the home environment for tripping and slipping hazards. She is also vague about the connection between hip fracture and death, failing to cite the potential effect of mitigating conditions such as dementia or other diseases.
Brody's articles have become predictable in their pat answers and support of the pharmaceutical industry. Her reporting lacks scientific rigor and new, useful information and is not worthy of the NY Times or its readers.
58
MRSA is another huge risk for hip surgery. It killed my mom. She was walking better than in years, after rehab.
6
What about weight??? Especially for Women : TOO thin will absolutely destroy your bones, especially over years, AND the effects will often not be apparent until you pass menopause. That's when your bones will pay the price. Say yes to calcium rich foods, go UP a size. Or two.
22
The complications of fosomax and others are not rare. And there is no evidence that the calcium supplements you take go into your bones, in fact they increase your risk of kidney stones. There is no mention in the article of weight bearing exercises, which is the safest and the best way to have strong bones. Join your local gym and lift some weights three days a week. Save your money on these drugs and hire a personal trainer if you din't know how.
26
I experienced dysphasia and severe joint pain on bisphonates. Never going back; I do weight bearing exercise, yoga, try not to fall.
5
Re Calcium supplements: "The unnaturally large, rapid, and sustained calcium levels in the blood caused by calcium supplements may explain why calcium from supplements, but not from food, appears to increase the risk of heart attacks." https://nutritionfacts.org/video/are-calcium-supplements-safe/ I no longer take them, though I've been told for years to do so. Could have saved my money and who knows what else -- since the supplement industry is basically unregulated, many supplements do not contain what they say that they do, and may be contaminated and/or adulterated, may not be manufacture in compliance with Good Manufacturing Practices, are not proven safe nor effective -- so it's buyer beware.
1
HRT improves bone density, but it’s use dropped dramatically in the mid-2000s when the drugs were linked to cancer. Could this be a factor in the increase in hip fracture/osteoporosis? Another point: It seems to me that greater emphasis should be placed on preventing falls, which is the immediate cause of hip fractures. I’d love to know how many women with broken hips were offered physical therapy to improve balance and core strength BEFORE they fell.
16
Good questions. Thank you. I was offered Fosamax but given no other information about Vitamin D or weight bearing exercise after a bone density test revealed osteoporosis. Also, no information about physical therapy to improve balance and core strength. I fractured my femur (rushing down the stairs at night) and had a hemi hip replacement in February 2017. After a 6 week recovery, I immediately went to the gym (4 days a week) and added Vitamin D, bone broths and calcium combo pills to my diet. I also use a hand compounded bioidentical hormone. I will address osteoporosis with these tools rather than that pharmaceutical.
3
Your point about HRT sounds likely. People ran scared from HRT, even after the most negative effects were found to be linked to the study's use of progestin (artificial progesterone) rather than real progesterone, which had the opposite (favorable) effect.
1
The increase in untreated osteoporosis may also be related to the scare about menopausal women taking hormones. I was diagnosed with osteopenia at age 52 and told that the maximum amount of bone loss occurs in the first five years of menopause and then levels off and that I could help my condition by taking a low dose estrogen for five years (or until age 60). I was having horrible hot flashes at nights so I was already open to taking the hormones and being advised that the hormones would help my bones convinced me. There seems to have been a scare about hormones but I am told there is evidence that taking them until age 60 is ok. At the same time I requested being tested for Vitamin D and was deficient - not surprising given where I live and that I wear tons of sun screen. Docs don't seem to be routinely testing for Vitamin D deficiency - I had to request the test. I take 4000 IUs per day with my doc's approval and got my Vitamin D up to the 50s.
15
Jane I think you might need to do a little more research ... my late mother-in-law used Fosamax and had a very common reaction to it, spontaneous fracture, which is why so many stopped using it.
Life style is the answer, diet and resistance training are the sensible way to go, unless one has an extraordinary condition.
33
I have done my own research and this is actually not a "very common reaction," even though it happened to someone you know and is a known but not common reaction. Lifestyle changes are simply not sufficient for many people, if only, and rather than relying on anecdotal evidence and planting their heads in the sand, anyone in need of counsel should seek out a highly qualified rheumatologist who specializes in osteoporosis and will perform a detailed analysis rather than merely writing a prescription.
1
Along with my mother's green eyes and good skin I inherited a predisposition for osteoporosis. My mother suffered broken hips three times and a severe, disfiguring wrist fracture, and went untreated for osteoporosis. I eat well and exercise every day but the genetic lottery was a tough one to beat. My best advice if a bone density scan -- which all near-menopausal/post-menopausal women should have as a baseline -- shows declining bone density: SEEK THE ADVICE OF A SPECIALIST, A GOOD RHEUMATOLOGIST, JOINTLY WEIGH THE RISK FACTORS AND OPTIONS AND ARRIVE AT A DECISION THAT WILL WORK BEST FOR YOU. Determining the need for medication entails a complicated equation that weighs various risk factors (the genetic one is a biggie). I feel much better knowing that I made an informed decision based on discussions with my rheumatologist, who is a specialist in treating osteoporosis and a professor at a major medical school in NYC. The risks of the drug I take are extremely low when compared with the likelihood that I may suffer the same fate as my mother.
15
You are the lucky one, I too took the advice of a specialist. He is a rheumatologist who was supposed to be an osteoporosis specialist. Unfortunately, after 2 years on Forteo he suggested the new drug Prolia. I was told it was very safe. It wasn't for me. After 3 injections I had stress fractures of the hip and pelvis along with a couple of other "unpleasant" side effects.
4
The most important aspect of this problem is obesity. Almost all of us need to lose some weight. But most of us just can't seem to.
1
What about the role of magnesium in bone strength and the role of exercise, even just daily walking?
7
Surely prevention should be considered along with the treatment described in the article. Calcium and vitamin D in your diet helps to build bones. Start with some decent breakfast cereals.
3
Comments like this, while I'm sure well-intentioned, show a profound lack of understanding of the causes and treatment of osteoporosis. A healthy diet and daily exercise, both of which I practice and are insufficient, are often simply not enough if you are genetically predisposed to develop osteoporosis. In addition, too much calcium can be a bad thing, especially as we age. My internist, who is also a cardiologist told me: Remember, what's good for you bones may not be good for your heart. He said the regularly diagnosed regiment for calcium, 1200 mg. a day for post-menopausal women, can result in a build-up of calcium around the aorta, which can become a serous condition.
3
Calcium and D intake have NOT been found to be associated with lower fracture risk, in numerous studies, as cited in an excellent summary in this paper in 2014.
https://www.nytimes.com/2014/11/18/upshot/got-milk-might-not-be-doing-yo...®ion=EndOfArticle&pgtype=article
Several of the studies were quite large (~100,000) and decades-long, and some were useful meta-analyses reviewing only high-quality studies, or randomized controlled trials. The studies cited in the NYT article were published between 2009 and 2014 in The Lancet, the British Medical Journal, Journal of the American Medical Association Pediatrics, and the American Journal of Clinical Nutrition.
The bottom line for all of them:
No link between total calcium intake and the risk of bone fractures.
In fact there was some evidence in some studies that supplemental calcium increased the risk of fractures.
Vitamin K has not been as thoroughly studied, but is associated with reduced risk of hip fracture in men and women, and increased bone mineral density in women (per the well-known Nurses’ Health Study and the Framingham Heart Study). A May 2017 study in Metabolism (Vitamin K and osteoporosis: Myth or reality?”) identifies some contrasting data and shows that while further studies would be useful, low vitamin K intake in young and elderly women seems to be associated with bone deterioration.
2
Echoing Judy, and simply NO THEY DO NOT.
To clarify: I broke a hip 9 months after starting Prolia, despite being healthy and active. How. Going downstairs in low light. I missed a step, started to fall, and decided to jump. Bad decision. But, while I still had a high risk of fracture last year in the other hip, my scan did show noticeable improvement. All traces of osteoporosis in my spine are gone, too. At nearly 77, I would never refuse treatment.
3
My mother suffered her first hip fracture at the age of 40, although no one gave any thought to osteoporosis until she broke the other one at 64 during an accident. Today, at 87, she's lost six inches in height due to spinal fractures. Her walking days are pretty much behind her. Given all this, I resolved more than a decade ago to begin a weight-lifting routine which has slowed my loss of bone density remarkably well. I also walk daily, but I realize not everyone is willing to make that time commitment.
What concerns me today is all of the young people who should be building bone density but aren't consuming enough calcium or getting the level of exercise they need. My prediction is 20-30 years from now, the problem will reach epidemic proportions.
10
I agree with your second paragraph. I taught in a community college for years and saw how the young women would drink sodas. Instead of pushing drugs, the medical profession should be encouraging a healthy diet and exercise for these women. When I was young I was never told that I would reach my maximum bone density by age 20. Perhaps the interest in exercise these days would help and prevent the epidemic; otherwise you may be right.
1
Fosamax prescribed years ago when, I now know, I had osteopenia. After that came other “bone building” drugs, including Forteo. I quit Evista two years before my endocrinologist prescribed one of the new injections. I said “no.”
By then I had read Lara Pizzorno’s book, Your Bones: How You can Prevent Osteoporosis and have Strong Bones for Life — Naturally.
Pizzorno suggests a plant-based calcium that builds strong bones, contrary to the masked, brittle bone so prevalent as a result of these osteoporosis drugs.
Pizzorno makes other sound suggestions on supplements, healthy food choices and beneficial exercise.
In my 70s and finally getting sound advice and using it to take charge of my health — what all of us should do every day of our lives.
15
My guess is that the side effects of bone drugs are not rare; it is rare that doctors will attribute them to the drugs. I have two relatives who took various bone drugs in their 60s. One had the "rare" hole in her jaw. The other, who had gone a lifetime without so much as a fracture, had a severe and unusual break in her arm after a minor fall. Both then refused to continue the treatment--and are still being hounded to resume it. I'm surprised there is absolutely no mention of these drugs imparting "density" to improve scan scores, not necessarily to improve bone health. As always with medication, you are our own best--and often only--advocate. Please do your own research before you take this article at face value.
31
Is it inappropriate to ask the experts you quote, whether, and how much, they are paid in consulting and speaking fees by the manufacturers of these drugs?
25
A friend is on tamoxifen and was told it would have a beneficial effect on her bone density. After two years on the drug, she found that was true. Her bone density is no longer falling. Does tamoxifen have the same jaw and femur negative effects? If not, how does this drug work differently? Do all women on this drug benefit in this manner or only some? Thank you.
5
"tamoxifen treatment is associated with a significant loss of BMD in premenopausal women, whereas it prevents bone loss in postmenopausal women. These adverse and beneficial effects of tamoxifen should be considered in the assessment of the therapeutic benefits for both the adjuvant treatment and the chemoprevention of breast cancer." https://www.ncbi.nlm.nih.gov/pubmed/8558225
I am currently taking tamoxifen; it is not without side effects. Or, as one oncologist said, his patients "suffer years of low grade misery." And those are the "benign" adverse effects; the others include increased risk of thromboses and uterine cancer, up to and including death.
Taking alendronate ("tentatively") for early stages of osteoporosis, but frustrated by the lack of solid data. The comments here provide a microcosm of the confusion out there: website links to scientific sources whose authority we can't evaluate; endless personal anecdotes; advice we already know about but is useless or questionable (what about lactose intolerance and unrelated problems that rule out certain types of exercise; is yoga a cure-all or dangerous) And: could it be possible that a snowballing process of scary anecdotes and snake oil click-bait are creating a new anti-vaccine type movement around these drugs?
The problem boils down to two crucial questions: Are biophosphonates actually effective, and how should doctors and patients evaluate the low-probability, high-consequence side effect issues? Who's collecting ongoing data on side effects, and how reliable is it: oral health professionals and orthopedic surgeons are in a good position to gather clinical data, but is there a clearinghouse for reliable data collection and analysis? Is that even possible if it's in no one's interest financially to help old ladies maintain their mobility and independence? It really needs rigorous analysis by impartial entities. Traditionally that has been the province of government and academic research, but someone needs to fund them. (NIH, are you still out there?) At any rate, thanks to Jane Brody and the NYT for covering the issue: please continue to keep us updated!
8
I had the surprise of my life when, at the age of 39, I was diagnosed with osteoporosis of the spine and osteopenia in the hips and femur. In the following 10 years, I was put on a regimen of alendronate once a week and calcium supplements twice a day. My bone density improved markedly, to the point when the doctor discontinued the medication and told me to obtain the extra calcium I needed through dairy products such as milk and yoghurt. I'm now 52 and all my bone density scans have been normal in the last few years. As a layman who did some reading on the topic, I believe that most people are unaware of how hard it is to get the minimum daily intake of calcium. Green leaves are an important source, but absorption by the body is more effective when it comes from dairy products or, alternatively, I think, from a high intake of soy milk.
9
This is a good point about calcium intake. In the US, only about 35% of individuals get enough calcium daily - especially a problem with kids.
6
I agree. I have always had a calcium rich diet. However, with age often comes an inability to absorb calcium. I was horrified at 73 to learn I had severe osteoporosis in both hips. I started Prolia shots every six months, plus 2000 mg of vitamin D to help with calcium absorption, but two years later broke a hip. Fortunately, I'm active and slim, knew to request the anterior approach, and was driving and walking normally two weeks later. I had a Reclast infusion last year, after another scan showed high risk of another fracture. Medicare pays for a bone scan every two years. I hate to wait that long to see if there's any improvement. I want to get back on my bike.
4
How much is enough for a 60 year old woman?
There was no mention of stress fractures. Stress fractures could be contributing to the overall increase in fractures among older people. Running on hard pavement caused me to get a stress fracture on the upper femur, exactly like the image at the top of the article. After it healed I switched to the stationary bicycle and elliptical machine to get the same cardio workout as running but with virtually no impact. Where there's a will there's a way.
10
I have osteopenia and have had for a decade. I've tried them all. I get "pins and needles" in my hips for 30 minutes and have to pace the floor. Who knows what else Fosamax, etc., are doing to me?
In August 2016 I was thrown into a window by a roller chair where I fell on to a tile floor. I broke my humerus but not my hip or forearm. My arm was horribly bruised because my whole body fell on it.
I don't want my bones to disintegrate but I don't want to take that medicine either. I get scanned every year and my spine and hips have actually improved since 2010. I'm making an informed decision.
6
No, you're not. I've had absolutely no side effects from either a Prolia or Reclast, but at 77, a broken hip might kill me.
1
You don't have osteoporosis - where the decision may be critical. AS far as I understand there isn't a good medical reason for use of alendronates for osteopenia.
2
Get a scan. In my early 40s a scan showed I was already significantly down in bone density (43%). Fosamax reversed the bone density loss. No surprise since my mother, aunt, and great aunt had all had broken hips, forearms and legs despite exercise and calcium rich diets. My mother broke her hip at 43 in a fall on black ice.
But beware the osteopenia v osteoporosis categories. They have changed over time. Osteopenia is very restrictive. If instead you have differential bone loss, it can indicate osteopenia. I have decided bone loss exactly where my mother's hip broke but not "uniform bone loss" so my category changed over time.
I only wish some research existed on Fosamax and statins in women. Both impact calcium. Statins were tested in 8,000 men.
5
I wonder if better shoes would help, or, better yet, lots more time with no shoes at all. I watch older people walking around in these shoes with thick, stiff, heavy soles that don't permit natural toe spread, and I am not at all surprised that they fall. Naturally-shaped footwear without a big lump preventing the arch from moving (aka "arch support" - the arch IS the support) would go a long way toward improving balance and overall function.
17
I have worked in nursing homes. I wonder who in the world designs them. Many fractures occur when patients fall in their rooms. The floors are concrete underneath a composite tile. Ugh. The injuries could be greatly decreased if a gym flooring of rubber would be used. You know they work when the mastodons in the gym drop 300 lbs. of weights directly on the floor and you look on in amazement that everything and everyone is still standing or sitting upright.
Imagine the amount of money and trauma that could be saved if this was done. It would be a far less expensive solution to what we have. It would save untold amounts of Medicare money and essentially people's lives.
Not every architect or designer knows how to make safe places for disabled, aged or even very young people. What looks good and passes code for a building may not work for a human body.
94
You are absolutely right. There are way too many falls and fractures in many facilities.
7
Yes. First time I have even seen this idea recommended. It would prevent not only broken bones, and more often, bruises, but concussions and subdural hematomas from falls which are far more common than most people know. I imagine arguments claiming that they would be harder to clean or less durable, but the injuries would decrease ( altho' nursing homes don't foot the bill for the injuries - there would have to be a carrot to encourage this -and a big stick on the other side))
3
Fosamax gave my mother stenosis in her carotid artery, which caused atrial fibrillation, which in turn caused the stroke that killed her. Although she was in her late 80s, she was otherwise in perfect health, and her brother and sister lived into their 90s – my uncle was 97 years old when he died.
Scans suggest that I have osteoporosis in my spine and wrists, as did my mother, but I have never had a fracture. I am in my 60s. I take magnesium and vitamin D, and eat plenty of yogurt and green, leafy vegetables. I try to spend at least 30 minutes per day outside, because UV rays are essential to the absorption of calcium and building bones. I cannot take calcium supplements for the same reason that Fosamax killed my mother – I do not absorb calcium well. I exercise daily and have done so since my late 20s.
I understand the statistics, but will not take the drugs that killed my mother.
52
I agree. Side effects of osteoporosis drugs are too risky. Some have been removed from the market. I try to eat well, I eat yogurt every day, take vitamin D, and am careful when I walk. I wear thick soled Frankenstein shoes for balance.
4
'Her advice is three-pronged: “medication when appropriate, an adequate intake of calcium and vitamin D, and don’t fall.”'
In order not to fall, we need strong, functional, powerful muscles which improve our coordination and balance. Despite its misleading name, Vitamin D is not a nutrient found naturally in food, unless you eat polar bear liver. Vitamin D Is a hormone, made in the skin by all higher animals, including humans, in response to UVB in solar radiation.
We don't need to take Vitamin B – we need to make it. Not by lying torpidly in the sun, like a beached whale, roasting our bodies and permanently damaging our skin. But by being physically active outdoors all year round, every day, in the sun, in the rain, and in the wind,
This allows us to use, tone and strengthen our muscles, as a result of which our skin glands produce a healthy, sweaty grease that in turn helps lubricate, nourish and protect our skin from sun damage while our skin makes vital Vitamin D.
15
Until you don't absorb vitamin d from the sun anymore. Your post is good, but age changes everything. I have osteoporosis despite doing all of those things.
3
If there was a healthy treatment available and administered by western medicine, more people would want to be treated.
13
There is also science that indicates that the way these drugs work can be damaging to bines
6
Could not tolerate any of the oral drugs. Now my doctor thinks I need to go on one of the injectables or infusions. Not buying it. An element of trust was lost when docs rushed to prescribe HRT to most of us years ago. Then rushed again to treat with bisphosphenates in early osteopnia. They need to stop drinking the big pharma koolaid. Doctors have no one to blame but themselves for this lack of trust. The treatment imperative at work. If we have a drug or a treatment we must use it.
24
People are not getting scanned because they have read the data and will not take medicine that could hurt them. I do not plan to get scanned and "treated". I would like to see a more detailed breakdown of the data. Who are the people who die within a year? Are they like my father, who had advanced Parkinson's and Dementia or are they active and otherwise healthy?
35
Exactly! A friend of mine broke her hip in a biking accident 12 years ago. She recovered and is still biking, now well into her 60's. My neighbor fell and broke her hip 10 years ago and is still going strong, well into her 70's now. I suspect that the people who die soon after breaking their hip are already in a nursing home or very close to it, and have other disease processes going on.
25
People who are ill. I breezed through surgery for a broken hip, and recovery, even though I was in my mid-70s. I would if I broke the other hip today.
3
I agree. My mother tripped on her front porch and fell and broke her hip in her mid 80s; she had surgery to repair it, and recovered so well that she asked for another surgery to remove some of the metal parts that were bothering her (she said she had "less padding" so it was uncomfortable). She lived to 93 -- and died of other causes, not from a broken hip.
4
Magnesium plus exercise.
17
I was prescribed Fosamax, Ms. Brody. If it really does prevent falls, I think it's because a patient who is spending all day on the toilet suffering from cramps and diarrhea is not likely to lose her balance. It's not much of a life, though.
70
Fosomax doesn't prevent falls.
2
You missed the joke.
5
I think this is the result of the 10-minute primary-care physician visit syndrome. I'm fairly high risk-- small, thin, white, with a Dad who took a bisphosphonate for years. But no doctor I have ever been to has suggested a bone density test. I had to set it up myself. In my experience, primary care doctors have become only reactive, not pro-active. My cat's vet is more pro-active...
58
It's great that you have been proactive about your bone health. Primary care is so saddled with other issues, that bone health rarely comes to the top of the list. It is really important to advocate for you and your family, especially if you are at high risk.
1
It's all very confusing. I was told to take Forteo for two years but my insurance refused to allow me to procure this injectable which must be kept refrigerated through my pharmacy. They insisted it be shipped in 80-100 degree weather through a mail order pharmacy. I said no thanks.
The cost is something like 3 grand a month. And if you travel a lot internationally, how are you supposed to juggle the shots and keep the médecine refrigerated all the time?
After two years, you are supposed to go on another med immediately for an additional 5-7 years to prevent losing the bone you just gained. So how much is THAT supposed to cost on top of the $72,000,00 for the Forteo? And what about the side effects?
I've waited a year and have done nothing. I looked at Fosamax and that doesn't seem good, either.
I'm eating healthy, walking, exercising with weights and trying to avoid falls.
Osteoporosis is a serious disease. It shouldn't be this costly or complicated to get treatment and to prevent further deterioration from this insidious disease. Our health care system in the US is abhorrent and greed-driven.
77
Please find a better doctor, such as a rheumatologist specializing in osteoporosis, and have a discussion about short-term drug and long-term non-drug/lifestyle treatments.
Follow the money, drs stopped prescribing this garbage after bisphosphonates went generic. Billion dollar drugs get marketed, advertised,freebies to drs, heavily promoted. Cheap generics with questionable benefit have no advocates. Drs heal thy selves first. There’s always Prolia and Forteo, I’m sure their sales reps will buy you lunch.
31
companies cannot "wine and dine" Dr's anymore.
1
I'll never forget overhearing a conversation between two women about osteo drugs. One woman mentioned to the other that she was taking a well-known drug(maybe Fosamax) even though she had no signs of osteoporosis. The other woman asked her why she was taking this drug if she had no indications of osteoporosis. The woman taking the drug replied, rather smugly, "Oh, MY doctor says EVERYONE should be on osteoporosis-preventing drugs.
There you have it in a nutshell: BigPharma strikes again.
54
No, you have an ignorant doctor and an ignorant patient - a great team. Not "BigPharma"
1
At 92 my mother at her annual health checkup was told she should take Fosamax. She called me and was very concerned about whether she should start the program or not? I said, "Not." At that age, what's the point?
BTW twenty days from now she'll celebrate her 101st birthday. Still living independently!
5
I have osteopenia in my back and hips. Both of my parents had osteoporosis in their 70's and 80's. I take some calcium and am religious about my D3. But I am very leery of taking biophosphonates because I am already at risk for osteoradionecrosis as a result of radiation for head and neck cancer. My risk is less than that of others as I had all my teeth pulled so I have less chance of infection, but I feel the added risk is not worth it. So I take raloxifene (generic Evista) instead. It does not have osteonecrosis of the jawbone as a side effect. It has not got worse in the last 7 years.
12
Another example of a few, rare complications of treatment driving the narrative to treat in the first place. Every medical procedure or intervention has a small but real complication profile. It's always risks vs benefits. With bone fractures it's not in only 30% mortality at 1 yr for hip fractures in the elderly. It's the profound effect of quality of life. The media again responsible for hysteria related failure to treat responsibly the ravages of osteoporosis.
17
With hip fractures, if you are over 75....it is very likely to take an independent senior with a high quality of life and put that person into Assisted Living, so that they lose their independence....have their cost of living dramatically increased (AL is expensive compared to your own home or apartment!)....and have their mobility reduced considerably, as they are either in wheelchairs or a walker for the rest of their lives.
Even if that broken hip is repaired competently....it is "never the same" and you simply never have the range of motion or mobility that you have with your natural hip joints.
2
Interestingly, if you look at the data, there is not a connection between low bone density and fractures. So why take these drugs, which have side effects?
Perhaps something else was at work in decreasing the numbers over the time period mentioned. This article makes it seem the Brody is working for the pharmaceutical industry.
61
My first question reading the article was who was the author. I was sure it was a doc or someone from BIG Parma. I was shocked it was Jane Brody.
1
The quality of some recent articles in this section has been questionable at best, and some downright misinformed.
The osteoporosis thing became an industry in its own right. Testing, and then prescribing bisphosphonates for everyone. The drugs have never proven to have an adequate safety profile re side effects and number of patients needed to be treated to prevent a serious fracture.
Plenty of reasons why fractures could decline, and then rise again. 60 is the new 40 and all that, older patients living healthier lifestyles. Better diets, more exercise. Less confounding medical problems that could cause one to fall. Then as more of the population becomes elderly, those benefits seem to disappear because the denominator becomes that much larger.
This article seems like an advertisement for the osteoporosis industry.
85
Let's set the record straight about bisphosphonates. These "wonder" drugs do not make the bones stronger. They make the bone older and more brittle.
As an Oral/Maxillofacial Surgeon, it was our specialty that blew the whistle on indiscriminate writing of prescriptions for these drugs 2003. We started seeing jaw bone death as the result of these drugs--small percentages, but catastrophic. I've tried to treat fractured bisphosphonate exposed bone and it's like working with chalk. If these drugs are used, they should not be used greater than 2-3 years because the 1/2 life of Fosamax is 11 years---11 years before 1/2 of the drug has left the body. There are other options.
139
Stop with the anecdotes. Do your homework. You can eat kale all day and never increase your bone density. There are thousands of researchers around the world working on bone research. I know I am married to one. I have been to dinners with these scientists and all they do is talk passionately with each other about their work. And they are academic scientists not pharmaceutical hires. I have seen the slides showing bone before and after the use of these drugs and believe me the difference is visible and dramatic. Insist on a bone density test if you are Post menopausal, have a family history or have broken a bone in a fall. Of course when the doctor says don’t fall she means all that entails such as better muscle strength and balance, good lighting, being careful when medicated or drinking. Educate yourself with real science not people making money by selling you supplements, special diets, or more voodoo.
66
Thank you for being the voice of reason here!
12
Thank you, Ann! Sound advice and more helpful than individual anecdotes. I would like to think we have advanced beyond some of the pseudo-scientific approaches commented on here. Wear better shoes? Eat prunes? Probably won't harm you but also won't help if you really suffer from osteoporosis.
2
Thanks, Ann. We've seen and talked to thousands of people whose lives have been destroyed by preventable fractures. This doesn't have to happen and we need more awareness of the risks and steps to take to prevent bone loss and fractures.
2
Concerning the osteoporosis, most of us don't realize that we are recontaminating our body by the toxic metals, mercury, lead, aluminum etc., that have been bound on our bones for years and are being released gradually when bones are getting degenerated. Dr. Dale Bredesen of University of California, who has been treating over 600 early Alzheimer's patients through his network of doctors that follow his protocol, has found that quite numbers of early Alzheimer's patients, most of whom in the 50's and 60's, are suffering from toxic-metal( mostly mercury) caused Alzheimer's. Though Osteoporosis occurs for men as well, but he has found so far more women are suffering from mercury-caused Alzheimer's. Unfortunately, most of doctors have very limited knowledge on toxic metals and chemicals that cause so much of chronic or degenerative diseases. These toxic metals need to be excreted carefully from our body without recontaminating our body in the process. In spite of the increasing danger of toxic metals and chemicals from foods, water and air, our current medical services are impotent to treat or to give us advice.
5
Can someone with a medical background comment on this please? Is it true?
4
We are left alone to tackle this kind of health issue. I recommend to read the following 2 books to read for your research.
The End of Altzheimer’s by Dale Bredesen
The Toxin Solution by Joseph Pizzorno
Most Americans are contaminated by metals, like mercury, lead, arsenic or aluminum that levels exceed healthy range, according to many metal experts like Dr. Joseph Pizzorno or Dr. Dietrich Klinghardt. On top of that Osteoporosis recirculates toxic metals wound on bone cells for a long time into the blood system. Though Dr. Dale Bredesen of UCLA mentions that he is not sure why so many women in the 50's or early 60's suffer from mercury-caused Alzheimer's, he points out perhaps it may be because of osteoporosis. The most common cause of Alzheimer's is excess blood sugar and excess insulin. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712873/
We also need to pay more attention to the warning on glyphosate (toxic chemical) by Dr. Stephanie Seneff of MIT that causes all the kind of metabolic diseases though nobody so far connected glyphosate to osteoporosis.
"In Summary, for those who took the bisphosphonates:
Benefits in NNT
None were helped (fracture prevented after 3 years of medicine)
Harms in NNT
A small number were harmed"
http://www.thennt.com/nnt/bisphosphonates-for-fracture-prevention-in-pos...
Moreover, bone density represents only about 1/6 of the risk of bone fracture; the other 5/6 risk of fracture include: poor eyesight; poor lighting; poor muscle strength and balance; trip hazards and clutter; lack of railings. Why doesn't the medical profession address these other risk factors, which don't require meds with potentially serious adverse effects, and which if improved also improve overall health and quality of life, with no adverse side effects? Could it be: $$$ ?
146
Bingo, Dr.
7
Consult an Occupational Therapist. She will help you identify the problem areas and take steps to correct them. Placing outlets at countertop height instead of near the floor helps both the elderly and toddlers.
Healthy hips don't fracture easily.
Better living through chemistry? This is a pro big pharma article, but after years and years of a lying industry (oxycontin) it is hard to sort out the truth. Having a liar in the oval office further erodes big pharma’s credibility. Not only does this article fail to even mention regular load bearing exercise, but it fails to address that some bone measuring tests (like those the average person can easily afford) are not just completely worthless, they are actively misleading.
If big pharma wants credibility, dump trump and clean its own house.
24
Mostly I agree, but what on earth does TRUMP have to do with Big Pharma? this system has existed for at least the last 25-30 years! and that means "under Clinton and Bush and Obama" -- so putting all the blame on Trump, who has only been in office ONE YEAR is just ridiculous.
2
You don’t want to make it that far in life only for something preventable to stop you.
2
I've recently read of a connection (not proven, but suspected) between proton pump inhibitors for acid reflux, which eliminate stomach acid thereby reducing calcium absorption, and osteopenia / osteoporosis. I now take calcium citrate, which does not require an acidic environment for absorption, as well as 2000 IU of Vitamin D per day. I have slight osteopenia of the spine (score of -1.1), and am determined to control this with diet and exercise changes (walking and other weight-bearing).
14
My osteoporosis is almost certainly linked to the PPIs that I took for 20 years . It was after reading about that link that I had the bone scan that showed the extensive damage to my hips.
Exercise does increase bone density, but only in the bones actually challenged. I read an NIH study that showed that significant reversal of osteoporosis and osteopenia was achieved by eating 6-8 small prunes every day for six months. In combination with exercise, this seems to be an excellent approach.
Then there are those of us who take steroids long term, drugs that induce osteoporosis in otherwise healthy people. It’s a nightmare for us, as we have no choice but to take these drugs.
10
My physiotherapist and I were chatting during a treatment when she said that in her opinion, 50% of hip replacements result in death. People don't do their rehab because they don't take it seriously enough, or their frailty interferes with their ability to do physical exercises and then regain the ability to do weight bearing exercise, such as walking. Inactive people are prone to illness, and then pneumonia takes many who had a hip replacement.
'Only' in my late 50's, I take calcium, do weight bearing exercise, have had bone density exam, and pay attention to potential fall and trip hazards in my home. Last week I bought a new no-slip rubber mat for my bathtub. Someone asked me why I did this. My reply: insurance.
13
I’m guessing that she meant “hip fracture” when she said hip replacement. The mortality from elective hip arthroplasty is very small, whereas the mortality from hip fractures are much higher in the first year after surgery. Same bone, totally different procedures and outcomes.
They quote the overall rate here, but it varies by age. If you break your hip at 60, it is likely very different than to do so at 80 or 90....the 60 year old will almost certainly make a full or near-full recovery and go back to walking, driving, etc. The 85 year old often will not -- the physical therapy is too hard -- they are often lonely & depressed as well as injured -- they are weak, from age and from years of not using muscles. Seniors often have compromised vision and balance issues. Once you have a fall this bad -- that results in a broken hip -- and a LONG, long rehab period (months!) -- you become TERRIFIED of falling again -- so these fearful seniors won't push themselves to do more, out of that fear. They end up disabled, and going into nursing homes or Assisted Living....losing their homes, activities, neighbors, pets....being isolated among other frail seniors.
If you know anyone like this, you have witness the inevitable path of decline up close -- it is very sad.
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I am a very healthy 56 year old woman. I work out every day and watch my diet. Unfortunately, I have osteoporosis. I went to see one of the top doctors in this field and was told that I was dealt a bad hand. My sisters and I are all thin, but they do not have this disease. Getting osteoporosis is 80% heredity and 20% diet. My father, his mother and sister all had osteoporosis. I am currently taking Forteo, which is very expensive, but my insurance covers it. After trying to turn my osteoporosis around through diet and weight lifting, walking etc and to only see my numbers get worse, my spine number improved significantly after only 6 months on Forteo. I have 18 more months to go. I have had no side effects. My doctor expressed his frustration to me and my husband that women are listening to the media that only know part of the story. My advise is to find a doctor that you trust and follow his/her advice.
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Current medical treatments are not working well in dealing with degenerative diseases like osteoporosis, type 2 diabetes, Alzheimer’s, cancer etc. that require patients total lifestyle changes. However, doctors are not helpful because they are trained to prescribe medicines. They have limited knowledge on current researches, advices that researchers recommend, other than basic knowledge that they obtained at medical school. Unfortunately patients are left alone to handle these medical issues without proper guidance. Internet is very helpful and resourceful, but it is not easy to find right information that can become weapons to fight against degenerative diseases.
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No lifestyle change of any kind will prevent or treat Alzheimer's -- and it is unbelievably cruel for you to suggest this to suffering patients and their families.
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I believe in evidence based research, perhaps, like you. Dr. Dale Bredesen of UCLA has treated over 100 early Alzheimer’s patients with great result by 26 therapies including lifestyle changes.It seems that you are sticking to only-miracle-medicine-can cure Altzheimer’s dogma.Please read his book, The End of Altzheimer’s, and let me know your comment next time.
Science has been changing though your grasp of Alzheimer's has never been changed. Please read following research interview:
Dale E. Bredesen, md: Reversing Cognitive Decline
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712873/
Physical therapy, increasing core strength, should be the first therapy..this also helps with balance and general strength.
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I was one of those patients treated with bisphosphonates much longer than medically correct. I fell through the cracks, so to speak (no pun intended), since after about 6 years on Fosamax under care of an Endocrinologist, I moved and first had to find a new doctor. For another year, my MD ignored the guidance of more than five years of treatment leading to no benefits. Long story short, I switched docs, was reevaluated and taken off the Fosamax. I guess I'm lucky - no ill effects that I know of, and before I moved from snow and ice country, I fell on the ice many times and never broke another bone post Fosamax. I just had many X-rays preceding bilateral knee replacement surgery and got a good report on my bone strength. All my bone scans (one every two years) indicate my bone loss is minimal since all my treatment. For the past six years, I take only Calcium 1000 mg daily (various kinds just to mix it up) for my Osteoporosis. I recommend everyone especially women get a full body bone scan around age 50 which is when my full blown Osteoporosis was diagnosed. I'm now seventy.
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Most insurance plans won't pay for the full body bone scan before the age of 65. Even my primary care doctor (when he suggested one for me--I'm a few years short of the minimum age) was very surprised.
1
If you are less that 65 and have a risk factor for osteoporosis (family history, medical condition, previous fracture) you should be able to get insurance coverage. It may need prior authorization and a letter of medical necessity from your doctor.
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"Her advice is three-pronged: “medication when appropriate, an adequate intake of calcium and vitamin D, and don’t fall.”
Why no mention of weight bearing exercises and bone strengthening diets (as opposed to calcium pills) to combat osteoporosis before taking drugs? These same two self-empowering lifestyle modifications are recommended before taking drugs for high cholesterol and high blood pressure.
I am concerned that doctors are not encouraging their patients enough to try lifestyle changes before writing a prescription. My mother suffered severe digestive problems after taking bisphosphonates. She never tried the non-drug alternatives which her doctor never recommended.
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I can't tolerate Fosamax, but do well on Prolia and Reclast.
Last year I fell hard on the ice and broke a wrist - the physical therapist urged me to get a bone scan even though I was 56 yr old - because his mother also had osteoporosis - sure enough I have osteoporosis and the clinic doctor just told me to take vitamin D and calcium so I found another family doctor who proscribed bisphosphonates - I read the literature and decided that there was no reason not to take it, it is really no big deal. My elderly mother just fell and broke her hip, that is a big deal. The recovery is really terrible and something that I want to avoid. I have also started lifting weights and exercising regularly. I won't take these meds for very long since they have an extremely long half life.
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I think it is fair to say that most of us just don't know what to believe about these meds.
I make behavior changes that I believe will help (and if not, won't hurt). When in doubt about meds, I just say no.
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My wife has had a tooth implant and a root canal---and she takes Reclast infusion once a year for the last 3 years because she has reflux. She is 71. She had read about the horrible side effects in the NYT and had a few sleepless nights before the implant---but she had no choice. Tooth had to go---and the bone medicine was already in the body. She is fine. She is careful not to fall. But her mother and my mother did fall and were never the same---there are complications to hip broken bones surgeries sometimes---blood clots, head iinjuries as well, etc. We do need more research---
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Don't fall is the best advice! But, a little good news. My mom broke her hip at ninety one! If someone at eighty or more does that, it's usually lights out! However, within much less than a year, of having a hip replacement, and after rehabilitation, she had a cane for three weeks, after which, she tossed it away. She walked with a snap in her step, for the rest of her life, and made it to a rather vigorous one hundred and one, at which time, as she would say, she kicked the bucket! And that was in her own apartment and bed!!!
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God bless your mom, but she was really VERY lucky -- lucky genes -- we sadly all are not this fortunate.
2
The drugs for osteoporosis can be hard on the digestive track. My primary recently asked that I have the endocrinologist prescribe an annual infusion in lieu of the monthly pill.
Also, I have been getting my Deca scan every 2 years for quite some time. I have had osteoporosis for several years. It's not bad but it's there. Recently, the radiologist said it was a little better and that whatever I was doing was working. I told her that I wasn't doing anything so she referred me to an endocrinologist. But for so many years I dutifully got the scans, had osteoporosis and was not referred or treated.
3
It's great that you are taking charge of your bone health.
Instead of treating people as irrational in fearing rare negative side effects, maybe point out the day-to-day painful, disgusting, life-altering affects this type of medication has on many, many users' digestive tracks. This is a medicine that requires significant lifestyles changes to manage it's impact on users' guts. One may end up with stronger bones but at the expense of self-induced IBS, which is a pretty terrible trade-off that rational people think long and hard about.
Also, getting this Rx requires users to add an expensive-to-treat diagnosis to their medical records. Who would do that during an era when employers are reneging on health insurance benefits in retirement and policymakers are having explicit public discussions about gutting Medicare? I had a bad break as a result of a bad fall (outside, exercising on an unanticipated slick surface) last winter, based on my age(53)/gender(f) the ortho desperately wanted me to have a 'baseline' test. No way. My employer had just stolen my retirement health insurance benefit, a material loss that shuts down the possibility of early retirement.
I've lost enough. The calculation doesn't work for me to ruin these great years when I'm totally healthy and physically fit by taking medicine that makes me chronically feel terrible for a future risk that may or may not come to pass.
Perhaps it would be interesting to have a convo about the way medicine perceives aging women as unworthy of a joyous, active quality of life???
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We think that many people benefit from the information they can get about their bone health (i.e., a bone density test or a fracture risk assessment). That way you can know your risk and take the necessary steps to prevent bone loss and fractures. It doesn't always mean medication.
1
Both my grandmothers and my father’s sister were disabled by hip fractures in their 60’s. Since my hysterectomy, I have followed my mother’s pattern and taken estrogen, as she did after hers. She never broke bone. For women without a uterus, the risk of breast cancer is not raised with hrmone replacement.
Knowing my family history, I have exercised with weight bearing exercise and weight lifting for most of my adult life. I fall fairly often because I hike over rough snowy ground. I don’t know if the hormones or the exercise are saving me, but I remain active and happy.
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Where are the research studies? From what I understand, bisphonates reduce the incidence of fractures by something like 3%.
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I wish this article had offered links to more detailed quantitative information on the pro's and cons of bone-strengthening meds. I'm a classic borderline case. At 77, bone scans show I have "moderate" ostopenia (which is the average condition for white women my age; my tests are actually a little better than average). Five years ago, after I slipped on an icy sidewalk and broke both my wrists, I started taking alendronate. (Personally, I don't think the prior cause of the breaks was weak bones; I was walking very fast and hit the ground with a great deal of force.) When subsequent bone scans showed no deterioriation (and the WHO Frax calculator would NOT recommend meds for someone with my readings), I was concerned about side effects. At my last checkup, I raised the issue with my doctor, and we agreed that I'd stop taking the meds for several years and reevaluate after another bone scan.
But my decision wasn't based on detailed data. That is, I dont know: What's the relative rate of life-altering fractures in old white women for those who do and don't take bone strengtheners? What percent of patients taking bone-strengtheners have serious bad side effects? Since I'm following the WHO guidelines, my decision might still be the same, but I wish I were a little better informed.
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Start with natural "bone strengtheners". Change your diet, avoid people who tempt you with junk food, always wear the proper footwear to prevent falls, etc. Read Andrew Weil's "Healthy Aging" book. Weil is a Harvard Med school grad.
Don't be obsessed med stats. When you've personally had a bad exp with bis-p's, you don't need stats; you just know they're not right for you.
The problem with FDA, WHO, AMA and all the mainstream med stat orgs is they're biased, according to how much money they can make for supporting big pharma's agenda. Healthy food and right exercise is your best medicine for healthy aging.
7
It's disturbing that no mention is made of diet in the devel of osteo-p. Its common knowledge among the better informed nutritionists that diet plays a role, starting with all the processed foods that people of all ages eat.
For the older woman, drinking carbonated beverages, too much coffee, etc., acidifies the blood which should be naturally slightly alkaline, according to what medical scientists have discovered about healthy blood. In the presense of acidic conditions, the body's homeostatic defenses combat acidic conditions in all body systems, and pulls calcium from any source it can find...first the bones and body tissues. (Calcium ion is necessary for basic nerve transmission). So bad diet sets the stage gets for osteopenia, then osteo-porosis.
But this fact is not popular in mainstream gynecology and internal medicine. I'm 64, I abandoned bisphosphates 10 years ago due to really unpleasant side effects, and changed my diet and exercise. I do not have to fear broken bones, nor do I have to scare myself by getting unnecessary DEXA scans.
15
Our bodies regulate pH very tightly, changing it is both very difficult and inadvisable. Diet won't change it, thank goodness.
5
It is very important to know that if one needs/wants dental implants, they must NOT be on biophosphonates... That info is missing from this article.. and PS my MD did not explain that to me when she wanted me to go on one of these drugs; my dentist did.
Medicare pays for bone density tests only every other year.
It's all very nice to write that X number of people die within a year of sustaining a major fall - breaking a hip; age of people should be noted and how many deaths occurred during treatmenet as in a hospital. My very sick 94 year old aunt died after a nontraumatic fracture of the ankle -- awaiting surgery to set the bone. A friends 80 some year old mother died after a hip fracture-- he suspects negligence on the part of the hospital...
MORE INFO NEEDED>...
22
I was prescribed Fosamax and later Boniva for osteopenia. After six years of faithfully taking these drugs my femur broke in half ona Sunday morning when I went out for the paper. It broke first and then I fell across the steps. Now I know I should have never been given these drugs as there is no evidence they prevent osteoporosis. Osteopenia is not a disease! The millions of Deva machines are a means for drug companies to prod doctors and patients into using drugs. They are meaningless because they can’t identify the quality of bone. A thicker bone is not necessarily a better bone. My surgeon said my bone was “mush” inside when he repaired the fracture. The mushy bone also meant that I had to have two more surgeries over two years before the bone healed. Women are rightfully afraid of these over prescribed powerful drugs.
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I am so sorry about your broken femur -- because you are absolutely correct. Bone density is not a good measure of bone strength, which includes both compressive and tensile strength, both important for preventing fractures. Exercise and diet are much more important for improving bone strength. I like my whole foods plant based diet; lots of scientific evidence that it may be the healthiest way to eat.
15
I agree. My sister had a spontaneous fracture of the femur and had to be air-lifted to the hospital. The first question she was asked was whether she was taking Fosamax. If these fractures are so rare, why was this the doctor's first question?! This is not as rare as the drug companies and many doctors tell patients. I won't take the bone-density test unless my doctor has alternatives other than these medications. The risk is just too awful.
20
Thank you, Jeanne. I am another “rare” one whose femur snapped after twelve years on Fosamax prescribed by two board certified, female physicians, my internist and rheumatologist. When I met the orthopedic surgeon who put a 17-inch titanium rod in my leg, he announced to me,”This is a Fosamax break.” Because of my insurance coverage, I had to switch to another orthopedic surgeon for followup care. He told me, “Bisphosphonates are evil drugs.” I am grateful that I am able to now walk two miles a day and do yoga, among other things, to protect my bones. Kudos to all of you who make informed decisions about your health.
5
Do weight lifting. I was unable to tolerate Fosamax due to acid reflux. I increased my bone density by weightlifting twice a week at my community gym.
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I know quite a few people who chose not to take these drugs, and I can understand why. Oral bisphosphonates are extremely inconvenient and unpleasant to take, and insurance are very reluctant to pay for the more expensive, injectable drugs. And the side effects are not trivial. Even though jaw necrosis is rare, dentists are reluctant to consider giving an implant (which quite a high proportion of older individuals will eventually need) to anyone who has a history of bisphosphonates. Try maintaining your high-fiber, plant-based diet, when you can't chew.
22
Ouch! But may I suggest an electric pressure cooker (I have an Instant Pot) for your whole food plant based diet? (where whole foods = unprocessed, and plant based = no animal products) Wonderful for cooking whole grains and beans, soups, stews, and more, and even some veggies and fruit (applesauce from unpeeled apples? yum!) Easy and fun! Delicious food! And: very easy to chew.
6
My mother and wife and several of their friends have refused to take these bone-sparing drugs like Fosamax because they made them ill and because of their reputation. They try to compensate
in other ways and have been largely successful.
19
Inadequately researched and tested, over marketed and poorly prescribed broadly to be a big money maker, Fosamax was to be one of Merck's golden eggs that they managed to turn into a rip roaring liability, not only for them but for the many patients harmed and those who could benefit from the drug therapy. Our current Administration is bent on allowing, not just Pharma but all large Corporations, free reign to do whatever means profit at the top by eliminating regulation and legal remedies for those citizens harmed by the greed masquerading as normal business practice. We will be reaping the rewards of this miserable stewardship beginning in the next few years and lasting for several decades of poisoned lives. Clearly, not Make America Great Again but Make America Sick, Tired and Morbid. As the GOP well understands, the cost of SSI, Medicare and Medicaid can be reduced, and reduced quickly, if we just take actions that "encourage" the retired, elderly and disabled to die off sooner rather than later. Unless, of course, you are a "retired" politician on the Government dole. Then you will be entitled to benefits no common citizen could possible deserve.
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Could it be that Fosamax was not adequately tested before coming to market and the recommendations were to take it forever? Could it be that our lack of unified medical records failed to detect the problems? Could it be that the difficulty in reporting adverse reactions limits what is known? Could it be that drug company profits are more important than the populations health? Could it be that this is primarily a woman's issue? We now have a distrusted and dysfunctional FDA. What are we in for now? Just asking.
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Sing it, honey! You are right & what can be done about this, I wonder?
6
Louise in America: I was part of the medically supervised year one test after its formal FDA approval and have been monitored ever since. I was carefully chosen based on scan and medical history (family history, life long exercise, no smoking, no other drugs, high calcium intake, Scandinavian ancestry) as well as because I am religious about following medicine directions. I have been taken off it and put back on at intervals over the years as is recommended.
Through my insurance (Medicare Advantage) Fosamax costs $7.00 for a three month supply.
1
I appreciate Jane Brody’s columns and, usually, practical information. This column does not address the elephant in the room! Why not talk about using exercise to cover lost bone? It is free and has many other benefits besides being one of the few ways to recover our st Ben and build new. The additional benefits include improving balance and overall strength. Many times, exercise can have the very beneficial side effect of connecting people and creating social interaction. NY Times recently had an article about the health benefits of this interaction.
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Yes, this makes me wonder if Jane Brody &/or the physician(s) she worked with on this essay work for the Rx company that produces these drugs. Quite the commercial.
18
I happen to be one of those patients denied Medicare coverage for a Dexi Scan. I'm close to eighty and have devastating arthritis with osteopenia and severe cartilage loss. Because of my physical condition, my activity level is compromised which only increases my chances for possible fractures. The Medicare denial of coverage for a scan is beyond perplexing. Certainly the cost for the test is much less than the cost of treating and caring for a hip fx, including coverage for poor outcomes in the elderly.
78
Medicare pays bi-annually.
2
What information do you need from the scan to determine your treatment? What decisions are affected?
3
I discovered that "screening" bone density scans were covered under the ACA, but "diagnostic" bone density scans were not -- and thus paid out-of-pocket in high deductible plans. And "diagnostic" means your doctor thinks you might already have osteoporosis (which the majority of the elderly do, I think it's like wrinkles and gray hair). I don't know about Medicare, since I don't plan on having any more bone density scans done.
And please note that taking the drugs are no guarantee of no fracture: At best, they reduce the risk slightly (probably not) but nowhere near to 0%.
5
Bisphonates have been tarnished in public opinion like statins. Patients expect side effects ... and so they have them.
5
No, not true. Bisphosphonates have known side effects which need to be accurately reported so that people can make informed decisions about whether or not to take them.
1
If you take a bisphosphonate and have side effects, you deal with it then. You don't know if you're going to have side effects of bisphosphonates unless you take one. Bisphosphonates are only indicated for osteoporosis. If you choose not to take bisphosphonates due to the FEAR of side effects, you commit an unforced error that you may not realize until near the end of life when you have a hip fracture that begins your final downward spiral. Or a spinal compression fracture that renders you in chronic pain for the rest of your life, ruining the tail end of your golden years. When someone is making an informed decision about the use of bisphosphonates, their medical provider should tell them about the risks of NOT taking one.
1
Following this logic, a person should not be afraid to try poison to find out whether it is going to make them sick or kill them.
As to making informed decisions, medical providers don't always have the answers, especially with regard to bisphosphonates. The drug companies have marketed them to make huge profits, and the research has only recently begun to reveal the life-altering dangers. Anyone whose doctor recommends taking a bisphosphonate should rightly be apprehensive, and should look at the research in depth before making a decision.
3
BTW, bisphosphonarates produce ‘harder bone, not smarter bone’. Ergo, the atypical fractures below the hip. These Rx’s best taken in concert with an activity program or a Physical Therapy/Occupational Therapy regimen.
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