Sticks, stones and bone drugs?
Sticks and stones can break your bones — and so, apparently can drugs that are meant to strengthen your bones.
I had to scratch my noggin over a new study that posits that drugs meant to strengthen bones for osteoporosis may actually contribute to an unusual series of thigh fractures in some patients.
This study put the spotlight on people who had been using bone-building drugs called bisphosphonates for five years or more.
Orthopedists have noticed a pattern with some who report aching in the legs over a course of weeks with no apparent cause. Then one day the thigh snaps while they are standing or walking — not as a result of a fall or trauma to the leg.
Many patients report that they felt the bone break before they fell — there was even a firsthand report in the medical journal "Geriatrics" from a 59- year-old physician who had been taking a bisphosphonate. In the new study from orthopedists at New York-Presbyterian/Weill Cornell, the same fracture pattern did not show in the placebo segment.
Bisphosphonates are popular in the treatment of osteoporosis, which is a contributing factor in the 300,000 hip fractures Americans suffer a year. Women are four times as likely as men to have osteoporosis. After menopause, many women develop thin, brittle bones and bisphosphonates have been used to combat this.
On a microscopic level, bones are constantly dissolving old bits and rebuilding new bone. It appears that bisphosphanates do unpredictable things within the body's bone maintenance system, sometimes resulting in an excess breakdown of bone — this common thread seems to run through several recent studies. I told you in a past House Calls about a study of Fosamax, a bisphosphonate that was connected to decay in jawbones in hundreds of patients.
Also troubling are reports that I am receiving from local dentists who are noticing abnormal bone changes on routine dental X-rays in patients on bisphosphonates. This is not the sort of thing that has made it into mainstream peer-reviewed medical journals . . . yet. But it certainly is worrisome to me. It's probably just the tip of the iceberg.
The problems with bisphosphonates are just another adverse consequence of the one-size-fits-all blockbuster drug mentality that still rules our health care system. It appears that some people are vulnerable to the harmful effects of this class of drugs that aggressively manipulate bone metabolism. Of course we cannot predict who will be hurt. This sort of collateral damage has been accepted by our health care system and medical profession as "OK". It is not OK, because there are plenty of safer, less expensive options whose main obstacle to use is their failure to boost the bottom line of drug companies.
Responding to the thigh-fracture study was a spokesman for one of the major drug manufacturers, who said the company's researchers would examine the evidence on the phenomenon. I think I can predict the future. Something tells me Big Pharma will find another explanation for this other than a defective drug.
Rather than relying on these questionable drugs, I point my patients in the direction of natural lifestyle improvements — making sure they are getting the right daily amounts of calcium, magnesium and vitamin D. As we age, our bodies' ability to make vitamin D decreases, so supplementation becomes critical.
You can get vitamin D in your diet by eating fatty fish like salmon or mackerel. Sun exposure also boosts vitamin D. You also need to pay attention to spending a safe, healthy amount of time in the sun (about 20 to 30 minutes, three to five days a week, with no sunscreen).
And if you live north of the Mason-Dixon Line, you should also take vitamin D supplements in the winter, since the sunlight just isn't intense then — no matter how long you spend outdoors. As far as getting your calcium, get a jolt from yogurt, milk, orange juice, salmon, cheeses, and oysters.
