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Only Rare Fractures Linked to Osteoporosis Drugs

Study: Bone-Loss Drugs Prevent More Fractures Than They Might Cause

Fracture Risk From Bone Drugs

Who is more at risk? Bisphosphonates slow the body's process of breaking down and remodeling bone -- a process called bone resorption. Black notes that increased risk has been linked to bisphosphonate users who take other drugs that prevent bone resorption, particularly corticosteroids.

He also notes that many patients who had the unusual fractures reported thigh pain before the fracture occurred. This may indicate a stress fracture -- so Black advises patients who develop thigh pain while taking bisphosphonates to see their doctors.

But it's still not clear exactly which patients are most at risk of these thigh/hip fractures.

"We need to sort out what is unique about these patients and if we can do something to identify them ahead of time and prevent the fractures," Bukata says.

One idea for safer bisphosphonate use is drug holidays. Bisphosphonates stay in the bone for a very long time. So patients whose osteoporosis is under control might be able to stop taking the drugs for a while.

"Is it a good idea to take a drug holiday? That depends on the patient," Shane says. "It depends on factors such as how low the patient's bone density is, how many fractures the patient had, and the severity of the osteoporosis. I do give drug holidays, but not necessarily always."

Black and Shane report receiving research funding from Merck and Novartis. Black has received travel reimbursements from the companies as well. Neither researcher reports any other financial interest in osteoporosis drugs or compensation from the companies that make them.

The Black study and Shane's editorial are published online in the New England Journal of Medicine.


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