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Osteoporosis: Are Bisphosphonates Safe?

think osteoporosis is a disease that most people don’t usually worry about. It’s one of those things that since you can’t SEE your bones or feel for deterioration, it’s not thought of.  The typical mindset is “I’ll worry about it when I’m older.” This is not the smartest way of thinking because your youth is the most critical time period to BUILD bone! The quality and quantity of bone established through diet and exercise caps at the very young  age of 18 for females and 20 for males.

Bone building begins to reverse itself at the age of 35 and when we don’t have the right tools to regenerate bone, osteoporosis occurs. Osteoporosis is a bone disorder where the bones degenerate, becoming weaker and thinner.

Calcium, phosphorus, and bone cells (osteoblasts and osteoclasts) are major elements of the bone. In normal everyday wear and tear, osteoclasts eat away at our bones, while the osteoblasts help to rebuild them!! It is CRUCIAL to keep these cells working properly so that our bones keep regenerating themselves!

osteoporosis bone

How Do You Get Osteoporosis??

Aside from being deficient in both calcium and phosphorus, estrogen helps control the amount of osteoclasts (bone breakers) in our bodies. When estrogen becomes low, like during menopause, the osteoclasts are not controlled and start degenerating bone faster than the osteoblasts (bone maker) can build them back up!!

Risk Factors

  • Being of the female gender.
  • Advancing age, especially in women who are approaching menopause (due to low estrogen)
  • Family History
  • Asians and Caucasians have a 5-10% lower bone density than those of African American or Mediterranean decent.
  • Women who are thin or have small frames.
  • Women with anorexia, celiac disease, diabetes, chronic diarrhea, kidney or liver diseases.
  • Smoking or Alcohol use.
  1. Try to squeeze in at least 2 sessions of weight-bearing activity a week.
  2. Consume your recommended amount of calcium and Vitamin D daily (Vitamin D helps calcium absorption in the intestine).
  3. Limit excessive alcohol consumption and quit smoking.
  4. Begin regular bone density scans by age 65 years.
  5. Be sure you are getting adequate magnesium in your diet as well. The ratio is 2:1 so if you are taking 1200 mg of calcium, you need at least 600 mg of magnesium.
  • Children age 9-18 years: 1300 mg per day
  • Adults age 19-50 years: 1000 mg per day
  • Adults age 51 +: 1200 mg per day

What If You Already Have Osteoporosis? Are Medications like Bisphosphonates (Fosamax, Boniva, Actonel) Safe?

Bisphosphonates alter the natural cycle of our osteoclasts and osteoblast bone cells in order to slow the rate of  bone loss, while increasing bone mass. These medications are used to prevent osteoporosis in post menopausal women, steroid-induced osteoporosis, and Paget’s disease of the bone. In short term use, of 3-4 years, these medications have been shown to slow/stop the reabsorption of bone, decreasing the risk of bone fracture and increasing bone mass in those with osteoporosis.

In those with breast cancer, bone density is lost due to low estrogen levels from chemo drugs; cyclophosphamide, methotrexate, and fluorouacil (CMF), which suppress estrogen. Post-chemo drugs like Tamnoxifen and Raloxifere, also lower estrogen levels and we already covered how low levels affect our bone regeneration!!

The Journal of Orthopaedic Trauma reported that a series of 20 patients taking Fosamax for an average of 6.9 years, presented with fractures. These patients had been complaining of aching thighbones for weeks or months and then suddenly broke their legs while standing or walking.

Two other new studies have shown that after long-term use (an average of 6.9 years) the bisphosphonates stop rejuvenating the bones and actually make them become brittle. This may be occurring because our osteoclasts and osteoblasts that repair everyday wear and tear are being stopped by the bisphosphonate drugs. This can lead to thinning and fractures after long-term use.

I am a firm believer that it is best to avoid medications whenever possible. They’re just not natural. Drugs like bisphosphonates are a proven metabolic toxin that kill the cells removing bone. This is a good thing right?? Not so sure…osteoclast and osteoblasts are a natural rebuilding process.

Other warnings about these drugs: may lead to osteonecrosis of the jaw, muscle and joint aching, atrial fibrillation, hip fractures, and esophageal cancer.

I have not yet come to a conclusion about my final thoughts on what to do about these drugs. I’m curious to open the discussion up and get YOUR views.

What to do when you HAVE osteoporosis but do not want to continue drugs?