Category: Bone and Joint Health

The Ugly Truth About "Bone-Building" Drugs for Osteoporosis

(And The Safe, Natural, Effective Alternative)

By Dr. Dana Myatt

Osteoporosis means "porous bone," a bone-thinning disease that affects some 25 million American women. It is called a "silent" disease because it comes on with few or no symptoms. Often, a fall resulting in a fracture is the first evidence of weakened bones. Other symptoms and signs of osteoporosis include a decrease in height, spontaneous hip or vertebrae fractures, and back pain. (Note: most back pain is NOT caused by osteoporosis, so don’t get hypochodriacal on me!)

In elderly women, death resulting from complications of hip fracture is far more common than death from breast cancer, yet few people realize the potential seriousness of this condition. Although osteoporosis is more common in post-menopausal women, it also occurs in younger women, in men, and in all age groups. Caucasian and Asian women are at greatest risk because their bones tend to be less dense to begin with.

OK, you get the picture. Osteoporosis is clearly a real health problem for many Americans. So it seems reasonable to take a medication that can make bones thicker if you’ve been told that you have osteopenia or osteoporosis, right? Please don’t go there until you consider these facts.

The Drug Is A Success – The Bone Died. ("To Save The Village We Had To Burn It Down")

The popular drugs prescribed for osteoporosis — alendronate (Fosamax, Fosamax Plus D), etidronate (Didronel), ibandronate (Boniva), pamidronate (Aredia), risedronate (Actonel, Actonel W/Calcium), tiludronate (Skelid), and zoledronic acid (Reclast, Zometa) — are all in a class of drugs called "bisphosphinates." (Abbreviated as "BP’s"). Although they are marketed as "bone-building" drugs, the real truth is quite a bit more ominous. These drugs work by killing a type of bone cell called osteoclasts. You read that right — the drug works by killing normal bone cells.

But Wait! There’s More! ("Other Than That, Mrs. Lincoln, How Was The Play?")

In addition to this insane "mechanism of action" (killing normal bone cells), the potential side-effects range from a mere nuisance to deadly serious.

Stomach upset, inflammation and erosions of the esophagus are a common side-effect of the oral forms of these drugs. But not to worry that this might be a sign that the drug isn’t healthy for your body. Your doctor will simply tell you to "remain seated upright for 30 to 60 minutes after taking the medication." Wasn’t that easy? Problem solved.

Bisphosphonates given by injection bypass the stomach troubles but have their own problems, including "flu-like symptoms after the first infusion." Manufacturers claim that this only happens the first time, but a quick search of online bulletin boards of people who have had this reaction tells a different story. Many people report severe flu-like symptoms and bone pain that was aggravated by each subsequent dose.

One study found in increase in "serious atrial fibrillation" among zoledronic acid (Reclast, Zometa) users, but the FDA dismissed this as "not significant." Since all these drugs are in the same class, however, the finding raises concern about this atrial fib connection and ALL bisphosphonate drugs.

[Nurse Mark Note: Atrial Fibrillation can quickly develop into a heart attack]

Last and not least, bispohsphonate drugs (ALL of them) are associated with a osteonecrosis of the jaw. In plain English, this means death of the jaw bone. The problem occurs more often with IV BP’s but is also seen in oral BP use. As one medical article stated, "This complication can have a significant impact on the quality of life for those patients with advanced stages of necrosis." Uh, you mean because the dead part of the jawbone will have to be removed and possibly bone-grafted? With resultant facial deformity (not to mention pain and suffering)? Yeah, that might ruin your week… or month… or life…

Is Bone Death Better Than Osteoporosis? (Is That Really A Serious Question?)

Obviously, I’m not a fan of bisphosphonate drugs. The class of bone cells that they destroy — the osteoclasts — help to "remodel" bone. This means that bone is supposed to be a living, growing, constantly changing tissue. Bisphosphonates change all that.

On the other hand, a life-threatening fracture from osteoporosis is no picnic, either. So what do I recommend for osteoporosis prevention and reversal? Nature’s way, of course!

Rebuilding Bone The Natural Way

It has long been known that declining sex hormones are associated with decreased bone mineralization. It is also known that un-natural hormone replacement, as practiced in conventional medicine, is a cause of breast and other hormone-related cancers (and increased risk of stroke, heart disease, blood clots and dementia).
The "middle ground" on hormone replacement therapy is to use natural (bio-identical) hormone replacement therapy as practiced by holistic medical practitioners. Following hormone testing (urine testing is better than saliva or blood tests), a custom formula using doses and forms as found in nature will be prescribed.

Normal bone formation requires the right "mix" of nutrients. Vitamin D is necessary for proper bone mineralization, and the latest medical research shows that we are getting far less than we really need. [NOTE: Maxi Multi’s have just been re-formulated to include 800IU instead of the previous 400IU per daily dose]. Folate, vitamin B6, B12 and vitamin K should also be in your daily "mix" and are found in optimal amounts in Maxi Multi’s.

Exercise, especially the kind that puts some stress on bones such as walking, help "tell" the bones to take up more minerals.

And of course, the minerals that build bone must be present. This usually requires mineral supplementation with calcium, magnesium, boron, manganese, zinc, copper and the "forgotten mineral," strontium.

Strontium, the "Secret Sauce" for Strong Bones

Strontium, a naturally-occurring mineral in the same class as calcium and magnesium, has been shown to prevent bone loss AND increase bone density even in already-established cases of osteoporosis. This, plus strontium (NOT the radioactive kind!) has little if any negative side effects. Read more about Strontium: The Missing Mineral for Osteoporosis Prevention and Reversal in this previous edition of HealthBeat.

The Short Course On Strong Bones And Bone Remineralization

Osteoporosis is not caused by a bisphosphonate deficiency! Given the potentially devastating side-effects of this class of drugs, doing it "nature’s way" should be a first choice for most people with osteoporosis (or those interested in prevention).

Exercise, sex hormone balance and obtaining all necessary bone nutrients including strontium will prevent and reverse most cases of osteoporosis without causing harm in the process.

References:

1.) Osteoporosis: Part I. Evaluation and Assessment. American Family Physician, March 1, 2001.
2.) Side effects courtesy of Merk’s Fosamax website: http://www.fosamax.com/alendronate_sodium/fosamax/consumer/side_effects/index.jsp
3.) Alendronate and atrial fibrillation. N Engl J Med. 2007 May 3;
356(18):1895-6
4.) Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis.  N Engl J Med. 2007 May 3;356(18):1809-22
5.) Osteonecrosis and bisphosphonates in oral and maxillofacial surgery. Oral Maxillofac Surg Clin North Am. 2007 May;19(2):199-206.
6.) Biophosphonate-related osteonecrosis of the jaws. Dent Clin North Am. 2008 Jan;52(1):111-28.
7.) Bisphosphonate Use and the Risk of Adverse Jaw Outcomes: A medical claims study of 714,217 people. J Am Dent Assoc. 2008 Jan;139(1):23-30.
8.) Osteonecrosis of the jaws secondary to bisphosphonate therapy: a case series. J Contemp Dent Pract. 2008 Jan 1;9(1):63-9.
9.) Bisphosphonate osteonecrosis of the jaws; an increasing problem for the dental practitioner. Br Dent J. 2007 Dec 8;203(11):641-4.
10.) Bisphosphonates and bisphosphonate induced osteonecrosis. Oral Maxillofac Surg Clin North Am. 2007 Nov;19(4):487-98, v-vi.
11.) The current state of postmenopausal hormone therapy: update for neurologists and epileptologists. Epilepsy Curr. 2007 Sep-Oct;7(5):119-22.
12.) Strontium Ranelate Reduces the Risk of Nonvertebral Fractures in Postmenopausal Women with Osteoporosis: Treatment of Peripheral Osteoporosis (TROPOS) Study. J Clin Endocrinol Metab. 2005 May; 90(5):2816-22. Epub 2005 Feb 22.
13.) Picking a bone with contemporary osteoporosis management: Nutrient strategies to enhance skeletal integrity. Clinical Nutrition (Epub ahead of print, 2006 October 12).
14.) The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis.” New England Journal of Medicine 350 (2004):459 – 68.
15.) Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: Treatment of Peripheral Osteoporosis (TROPOS) study. Journal of Clinical Endocrinology and Metabolism 90 (2005):2816 – 22.
16.) Strontium in Finnish foods. International Journal for Vitamin and Nutrition Research 52 (1982): 342 – 50.
17.) Gaby AR. Preventing and Reversing Osteoporosis. Rocklin, CA: Prima Publishing, 1994, 85–92 [review].
18.) Strontium ranelate: a dual mode of action rebalancing bone turnover in favour of bone formation. Curr Opin Rheumatol. 2006 Jun;18 Suppl 1:S11-5.