A very interesting and timely article

iVillage Member
Registered: 11-15-2007
A very interesting and timely article
7
Mon, 04-28-2008 - 1:47pm

I just got in an email.


Overuse of Osteoporosis Drugs



Time was, osteoporosis was diagnosed only in frail, elderly people with brittle, easily broken bones. Then Big Pharma developed drugs to treat it and suddenly this so-called "disease" became much more common -- and was seen to be endangering wide swaths of postmenopausal women. Over the years, the definition of osteoporosis was broadened to include even more women and greater awareness of osteopenia, a sort of "pre-osteoporosis" in which bone density is low but not so low as to constitute osteoporosis, was urged.


UNNECESSARY DRUGS WITH DANGEROUS SIDE EFFECTS?


Now it's hard to turn on the TV (or open a newspaper or go on-line) without being bombarded with ads for drugs not only for osteoporosis, but also encouraging women to proactively ask their doctors if they should take these drugs if they are "at risk," with hardly a mention of the very real side effects and dangers associated with them.


The drugs aren't so benign, however. The US Food and Drug Administration (FDA) has issued a drug alert for bisphosphonates (a class of drugs that includes alendronate and ibandronate), warning that they can cause severe bone, muscle and/or joint pain. Other side effects of bisphosphonates include difficulty swallowing, esophageal problems, gastric ulcer and bone tissue death of the jaw. Raloxifene (Evista), another type of osteoporosis drug known as a selective estrogen receptor modulator or SERM, increases the risk of blood clots and stroke. Ironically, alendronate (Fosamax) has been linked to femur fractures. (For more on the dangers of these drugs, see Daily Health News, January 18, 2007.)


MORE RISKS THAN BENEFITS FOR OSTEOPENIA


According to a recent report in the British Medical Journal (January 19, 2008), drug manufacturers regularly smudge the line between osteoporosis itself and osteopenia in order to sell more drugs. It's true that these drugs can successfully reduce the risk of fractures, at least in the short term, in people who actually have osteoporosis... and now that we're living longer lives, osteoporosis may become more common. But, says article coauthor Pablo Alonso-Coello, MD, a family practitioner affiliated with Hospital de Sant Pau in Barcelona, Spain, the benefits of osteoporosis drugs are exaggerated for people who just have osteopenia. "This move to treat pre-osteoporosis raises serious questions about the benefit-risk ratio for low-risk individuals, and about the costs of medicalizing and potentially medicating an enormous group of healthy people," writes Dr. Alonso-Coello. Not coincidentally, using current medical criteria, nearly half of postmenopausal women could be said to have osteopenia, which represents a huge and highly profitable potential new market for Big Pharma.


PLAYING WITH STATISTICS


In their research, Dr. Alonso-Coello and his colleagues looked at several studies on four drugs used by drug companies to demonstrate the benefits of such medications for women with osteopenia. They found that the results were expressed in a way that suggested the benefits were greater than they really are. Statistics can tell almost any story you want, after all.


Dr. Alonso-Coello gave me an example: Osteoporosis drugs are generally reported to reduce the risk of fracture by 50%... but it is important to look at "absolute" rather than "relative" risk. A woman with osteoporosis might reduce her absolute risk of a fracture from, say, 10% to 5% (which might be a clinically relevant benefit), while the risk for a person with osteopenia drops only from an already low 2% to 1% or even 1% to 0.5%. So calling it a 50% reduced risk in these cases inflates its clinical significance. He also warns that many study authors were employees of, or otherwise connected with, drug companies, pointing to a likely conflict of interest.


TAKE STEPS TO PROMOTE BONE HEALTH


Don't be swayed by the advertising. There are a number of strategies you can follow to prevent fractures and keep your bones strong and healthy as you age -- and they don't all involve drugs.


Among the non-pharmaceutical steps recommended by The National Osteoporosis Foundation to promote bone health...



  • Take in adequate calcium and vitamin D. Current daily guidelines for adults over 50 are 1,200 mg of calcium and 800 to 1,000 IU of vitamin D. D-3, or cholecalciferol, is the form of vitamin D best for bones. Taking a daily walk in the sunlight can also boost vitamin D levels.


  • Engage in regular weight-bearing exercise such as walking and dancing, and resistance exercises such as using weight machines or resistance bands. (Read more about safe exercises online at http://www.nof.org/prevention/exercise.htm, and talk to your doctor before embarking on any exercise program.)


  • Don't smoke at all and don't drink alcohol to excess.


  • Consider having a bone mineral density test if there is indication you need one. Dr. Alonso-Coello advises bone density testing not as a regular screening exam, but only for women who have had a previous fragility fracture or who have risk factors for a fracture (eg, a family history of maternal fractures). Early menopause may be another risk factor. (Watch for our upcoming story on a new way to determine who needs bone density screening in Daily Health News next month.)

Dr. Alonso-Coello additionally recommends instituting measures to prevent falls for older people. For example, use a walker or cane as necessary... wear supportive, low-heeled shoes... install grab bars on bathroom walls near the tub, shower and toilet... be sure your home is well lit... keep rooms free of clutter... and be sure carpets have skid-proof backing.


Osteopenia is not osteoporosis, and using drugs for prevention is not the same as using drugs for treatment. If you consider taking any drug solely as a preventive treatment -- especially if the treatment is long-term and has potentially serious side effects, as with osteoporosis drugs for osteopenia -- Dr. Alonso-Coello strongly advises that you seek a second opinion. Be sure to talk with your family physician and research treatment options before making your decision. With so many ways to keep bones strong naturally, medication should only be considered as a last resort.


Source(s):

Pablo Alonso-Coello, MD, family practitioner, Hospital de Sant Pau, Barcelona, Spain.








E-mail this Article


Be like a postage stamp.

Be like a postage stamp.  Stick to it until you get there.

Bob Proctor

iVillage Member
Registered: 10-15-2003
Mon, 04-28-2008 - 3:27pm

Great post.


Mom is having a terrible year with her health.

“You can only grow if you’re willing to feel awkward and uncomfortable when you try something new.” -Brian Tracy
iVillage Member
Registered: 11-15-2007
Mon, 04-28-2008 - 3:36pm
My step mom was on Actonel and she had terrible jaw pain and she still has all her own teeth at almost 80! So...she got off it and her jaw pain stopped.
Grace

Be like a postage stamp.

Be like a postage stamp.  Stick to it until you get there.

Bob Proctor

iVillage Member
Registered: 10-15-2003
Tue, 04-29-2008 - 9:04am

Fosamax is on the front page of the newspaper today.......heart issues too.


“You can only grow if you’re willing to feel awkward and uncomfortable when you try something new.” -Brian Tracy
iVillage Member
Registered: 11-15-2007
Tue, 04-29-2008 - 12:15pm
Good info Deb about the right foods to eat to help prevent osteoporosis.
Grace

Be like a postage stamp.

Be like a postage stamp.  Stick to it until you get there.

Bob Proctor

iVillage Member
Registered: 02-27-2001
Tue, 04-29-2008 - 8:35pm
Thank you, both Grace and C/C Deb for the information.
Nancy

"Make Choices that bring you joy"  cl-Patty


 


iVillage Member
Registered: 11-15-2007
Wed, 04-30-2008 - 11:14am

Hi, Nancy...I remember you writing about your stomach bothering you but I didn't realize it effected your teeth/jaw too and taking so long to get better from it. I hope things get back to normal soon.

Grace


Be like a postage stamp.

Be like a postage stamp.  Stick to it until you get there.

Bob Proctor

iVillage Member
Registered: 02-27-2001
Wed, 04-30-2008 - 11:41am
Actually Grace, it did not bother my teeth or my jaw.
Nancy

"Make Choices that bring you joy"  cl-Patty