Medical Edge Newspaper Column

Bisphosphonates and Osteoporosis

June 17, 2007
Readers:
Speaking of osteoporosis, a class of drugs called bisphosphonates has become the new mainstay treatment for postmenopausal women diagnosed with osteoporosis in the post-hormone-replacement era. Taking just one pill a week, or even one a month, may prevent, slow or stop the progression of this bone-thinning condition.

An estimated 10 million Americans, mostly women, have osteoporosis, a condition in which bones become weak and highly prone to fractures. Millions more have a less severe form called osteopenia.

Bone, a living tissue, is constantly remodeling, with old bone breaking down and new bone replacing it. Bisphosphonates help preserve bone density and reduce the risk of fractures by slowing the breakdown and reabsorption of old bone, an ongoing process that accelerates as estrogen levels fall during the first few years after menopause.

Estrogen once was commonly prescribed to reduce bone loss. But when the landmark Women's Health Initiative Study, released in 2002, showed that long-term estrogen use could increase the risk of breast cancer, heart attacks, strokes and blood clots, it fell out of favor for its use in osteoporosis prevention or treatment.

Bisphosphonates, such as alendronate (Fosamax), ibandronate (Boniva) and risedronate (Actonel), have filled the void and perform as well as estrogen in preventing bone loss.

Talk with your doctor about the best ways to prevent and treat osteoporosis. Bisphosphonates have potential side effects, most commonly heartburn and abdominal pain caused by irritation of the esophagus or stomach. Even with these medications, other bone-protecting steps are important: Take in enough calcium and vitamin D. Engage in regular weight-bearing exercise such as walking and weight training. And avoid smoking and excessive alcohol use.