Rethinking osteoporosis
Informed decisions about treatment for osteoporosis and osteopenia
by Dr. Susan E. Brown, PhD
There are several categories of drugs being prescribed in the name of bone protection. In this article we discuss the latest findings on the group known as bisphosphonates.
Further information can be found here on treatments and natural approaches to osteoporosis and osteoporosis risk:
Do you really need a drug for your bones?
If you’ve turned on the TV lately, leafed through a magazine, or surfed the internet, you’ve likely seen an advertisement warning you about bone loss and osteoporosis risk. And the ad most likely recommends a certain medication to prevent it. It’s true that many more people are suffering from osteoporosis today than in the past, but lots of people want to know if they really need to take Fosamax, Actonel, Boniva, or some other prescription medication to strengthen their bones.
Quite simply, my answer is no. In almost all cases, taking a prescription medication is not needed. People from around the country come to our bone center for a natural approach to strengthening their bones — and it’s been working for more than 20 years. Osteoporosis and osteopenia medications are big business, but despite all the hype and marketing from drug companies, there is a safer, more effective and natural approach to bone health available to you.
Prescription drugs known as bisphosphonates often do lead to initial increases in bone mineral density in those patients taking them, but the osteoporosis story is much more complicated than how dense your bone appears on a bone density scan. In many cases these medications don’t add any benefit in terms of fracture, and as we’ve been seeing lately, they may even hurt bone. Several patients have recently reported strange fractures after taking bisphosphonates for five years or more — something I started to see in my practice years ago.
Let’s take a closer look at prescription drugs for bone health, so you can make an informed decision about treatment for osteoporosis and osteopenia.
How bisphosphonates work — denser may not mean stronger
Bisphosphonates haven’t been on the market for very long, so we are still learning about their exact effects in the body. But we do know that the molecules in these drugs attach themselves strongly to the mineral surfaces in both cortical (outer compact bone) and trabecular (inner spongy matrix) bone to increase mass.
One way the drugs do this is by preventing trabecular perforations that can weaken bone structure. Another way is by interfering with cells that break down old bone — known as osteoclasts. This means resorption, the natural process of clearing out old bone, is inhibited, so that existing bone stays put for periods much longer than usual. But we now know that there is a lag time for the first six to 12 months after starting the drugs, when bone continues to build and stops being broken down. This initial uncoupling of the natural bone turnover process explains why results on bone density testing appear dramatic in the first year on a bisphosphonate. But after a year, things start to change, and bone volume plateaus.
Like the process of bone resorption, bone formation will eventually stop when on a bisphosphonate. Though the exact mechanism of action isn’t known at this time — we know that osteoblasts (our bone-builder cells) are inhibited by bisphosphonates. Research shows that after the first year, markers for bone turnover — growth and resorption — go down dramatically. So bone is neither building up nor breaking down once you’ve been taking a bisphosphonate for more than a year or so.
The question is: does this make bone stronger? In my opinion it’s always dangerous to work against nature. And though patients who take bisphosphonates may appear to have denser bone initially on a bone scan, it doesn’t mean the bone is actually stronger. In fact, we know that bone naturally becomes less dense as we age, but what protects us from debilitating fracture is our inborn ability to repair, meaning to break down old bone and rebuild new bone naturally. And because this natural bone repair process is halted when on drugs like Fosamax and Actonel, it is very likely that these drugs over the long haul will weaken, not strengthen, bone.
You may have read the recent news about people taking bisphosphonates for more than five years and spontaneously fracturing their femur bones while simply walking or standing. I had a patient who had been on Fosamax for four years, then simply turned in her bedroom one evening and fell to the floor, breaking her leg in two separate places. Though these “low-trauma” and “nontraumatic” fractures aren’t happening in all patients on bisphosphonates, they certainly serve as a warning for those considering prolonged use of these drugs as “preventive medicine.” It also points to the fact that halting bone resorption doesn’t automatically give us stronger bones, and may in fact make them more brittle over time.
To learn more on the topic of osteoporosis and bone loss, read our additional articles here:
Our Personal Program is a great place to start
At the Center for Better Bones we promote an all-natural approach to bone regeneration and repair that includes nutrition, diet, exercise, and lifestyle guidance. Our Personal Program is a convenient, at-home version of this approach.
- To assess your fracture risk and the health of your bones, take our free, on-line Fracture Risk and Bone Health Profile.
- To learn more about the guided, at-home Program we have developed with America’s premier women’s health clinic, Women to Women, go to The Personal Program for Better Bones.
- For more information about the at-home program for Better Bones, please call The Personal Program toll-free at 1-877-200-1269.
Original Publication Date: 01/01/2009
Last Modified: 06/24/2009
Principal Author: Dr. Susan E. Brown, PhD