Bone Loss Drug Linked to Rare Fracture
Long-Term Use of Osteoporosis Drug Fosamax May Weaken Long Bones
WebMD News Archive
Susan Bukata, MD, director of the center for bone health at the University
of Rochester, New York, says orthopaedic surgeons and specialists in metabolic
bone disease are well aware of this problem. Bukata was not involved in the
"This is not seen only with Fosamax. We see this in cancer patients given high doses of
Zometa as well," Bukata tells WebMD. "Fosamax was the most commonly
used bisphosphonate for the longest time. And it takes several years on the
drug before it seems to be a problem. So more people have been on Fosamax long
term than on
Actonel or the several other bisphosphonates."
What's going on? Bisphosphonates keep the body from reabsorbing bone. That
slows bone loss in osteoporosis. But it also interferes with the body's natural
That's why a growing number of bone experts suggest that after about five
years of bisphosphonate use, patients should take a "drug holiday"
until blood tests show their bone turnover increasing. It's done in Europe and
in Australia, and in a growing number of U.S. bone centers -- including Lane's
and Bukata's institutions.
"Remember, bisphosphonates go into the bone like money goes into an IRA.
Put money in now and it comes out, slowly, later," Lane says. "The
general thought is that after about five years of bisphosphonate treatment, you
stop for a year or two. And if bone-turnover markers go up, restart, and if
not, watch. Some patients on bisphosphonate holiday followed for up to four
years have not shown any change in these markers and are steady."
Meanwhile, Bukata warns patients not to stop taking their osteoporosis
"The average person should not worry about this -- and certainly should
not stop taking their bisphosphonates," she says. "We as doctors need
to be aware of this and start finding out who is at risk and why. But the last
thing we want is for people to stop taking their bisphosphonates because of
this type of fracture."
Lane notes that the rare leg fractures linked to Fosamax use are far less
dangerous than the hip fractures the drug prevents.