Dr. Gott: Osteoporosis drugs put into question

-Northwest Herald

08/17/2008- Dear Dr. Gott: I just read in The New York Times that long-term use of bisphosphonates for osteoporosis can lead to weaker bones in some people. Since I suffer from the disease, I am very concerned. I question whether I should discontinue my medication.

Dear Reader: You are referring to a small study reported in The Journal of Orthopaedic Trauma, disclosing patients with low-to-no-trauma fractures. A large portion of those in the study had been on long-term Fosamax therapy for an average of 6.9 years. Of particular interest: All of the breaks occurred straight across the bone, and some were preceded by weeks, even months, of unexplained aches and pains.

In the past, Fosamax has been associated with osteonecrosis of the mandible (destruction of the jaw bone) in some users. When this information was made public, I recommended all my patients on the drug switch to something else for control of their osteoporosis. With this newest report, I can only state my personal opinion, which is to stay away from Fosamax and consider other options.

While research is ongoing and positive strides are being made, it often takes years before we know the full story on any medication. For example, bisphosphonates are available in weekly and monthly doses through oral tablets, or annually by injection. Personally, I feel it is too soon to know of any possible long-term consequences that could develop while on these drugs. To compound the issue, by the time complaints are made and stories are correlated for similarity, years may have passed and the damage to bones might already be done. It’s a difficult dilemma.

Calcium supplements for men and pre-menopausal women should be 1,000 mg with a vitamin D supplement of 400 IU daily. For post-menopausal women, the appropriate dosing is 1,500 mg of calcium and 600 IU of vitamin D daily. The easiest way to accomplish this is to purchase a calcium supplement that also contains D, such as Citracal plus D or Caltrate plus D.