Only Rare Fractures Linked to Osteoporosis Drugs
Study: Bone-Loss Drugs Prevent More Fractures Than They Might Cause
Fosamax and Fractures continued...
Susan Bukata, MD, director of the Center for Bone Health at the University of Rochester, N.Y., agrees.
"These are real, but they are incredibly rare relative to the number of total hip fractures and the number of hip fractures saved on these drugs," Bukata tells WebMD via email.
Shane notes that the unusual fractures -- sometimes called hip fractures because they occur below the hip, and sometimes called thigh fractures because they involved the thigh bone (femur) -- make up only 2% to 4% of all hip fractures. And only about at third of these fractures are linked to bisphosphonates.
"Bisphosphonates are important drugs for preventing typical hip fractures, which are every bit as devastating as these unusual fractures," Shane says. "While they are important and of great concern, we want to find out who is at risk and tailor our therapy to reduce that risk as much as possible."
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."