New Orleans, LAA popular drug that has been linked to a rare debilitating condition known as osteonecrosis (bone death in the jawbone) is now under suspicion for putting some patients at increased risk for hip fractures if taken for more than five years. Fosamax (alendronate) is just one of several drugs in the bisphosphonate family that have come under fire lately with regard to bone health.
Fosamax is often prescribed to fight the effects of osteoperosis, a condition that affects 10 million Americans, with an additional 34 million suffering from low bone mass. Bisphosphonates aid in the slowing of bone loss and are among the nation's top sellers in the face of an aging population. Annual sales, according to the 3/11/10 issue of USA Today, exceed $3.5 billion.
It appears, however, that while bisphosphonates such as Fosamax help for a period of time, they can become a liability after long-term use.
Last week two studies presented at the Conference of the American Academy of Orthopedic Surgeons demonstrated that the bones of some postmenopausal women who take bisphosphonates such as Fosamax can stop rejuvenating and become brittle.
Joseph Lane, chief of metabolic bone disease service at the Hospital for Special Surgery in New York, studied bone biopsies of women who had atypical hip fractures of the femur and found the quality of the bone diminished after long-term bisphosphonate use. "Normally, bone is a distribution of young bone, middle-age bone and old bone," he told USA Today. "When we look at these bones, it's old bone."
According to Lane, the drugs are initially effective at slowing bone loss. However, the effect seems to be reversed when the drugs are taken for an extended period of time.
Melvin Rosenwasser, chief of orthopedic trauma surgery at Columbia University Medical Center in New York, echoes those sentiments. "These drugs are good drugs," he says. "They strengthen bone and protect you from fractures for a while. But in some people, they can become deleterious after a period of time." He points to bone density scans that reveal buckling potential in the femur area in patients that have been on bisphosphonates like Fosamax for four years or more.
The US Food and Drug Administration (FDA) is reportedly reviewing long-term use of bisphosphonates, but has yet to see the studies. In the meantime, Lane recommends that patients talk to their doctors if they have been on bisphosphonates for longer than four years. Routine bone scans are also recommended.
Ron Rogers, a spokesman for Merck, the manufacturer of Fosamax, said that causal association has yet to be established between Fosamax and femur fractures, together with fractures occurring in non-bisphosphonate cases. Rogers said Merck is funding studies "to further investigate the issue."
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