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My original post was referring to the potentially dangerous long term side
effects (bone death) of using a certain class of anti-osteoporosis drugs
known as biphosphanates, namely Actonel & Fosamax. These side effects do
not apply to over the counter dietary supplements such as calcium, vitamin
D, etc. that are marketed to improve bone health.
I saw my dentist again today. She re-emphasized that the greatest
dangers reported in the article she had read came from long term use,
especially IV administration of anti-osteoporosis drugs like Fosamax,
Actonel. She said using these in very elderly women who aren't expected to
live much longer probably wouldn't cause bone necrosis. But taking these
drugs starting at age 50 may cause bone necrosis if these bones are
disturbed by a routine tooth extraction, fracture or surgery. She promised
to get me the references to the articles she read. I'll post them later for
those of you who might be interested. The responses I received are
parapharased or directly quoted below in no particular order. If any of you
have responses that you wanted posted as part of my summary and you don't
see it here, I apologize. It was not intentional to leave out any
viewpoints. Soemtimes things just get lost in the shuffle. If you don't
see your views represented, please post them. ~Valerie in Tacoma
--------------------------
I have recently done a lot of research on these drugs and am amazed that
doctors hand them out so willingly. WRT Avascular Necrosis of the Jaw -
this is not a condition to laugh at. I have Avascular Necrosis (AVN)
bilaterally in the hips, knees and shoulders plus the spine and suspected in
the ankles, elbows and wrists). You have not had pain until you have
experienced the pain of your bones dying and decaying in your live body.
When your bones die the by products of necrosis (gas and water) have no
where to go because the outer bone traps it. The pain this generates is
nothing short of horrific. Western medicine has no cure for this disease
(though there are docs in
China who do). Mine is not as a result of biphoshonates but as a result of
corticosteriods.
What really upsets me is that for 10 years I battled chronic
corneal rejection and iritis and the only way to doctors could control it
was with massive doses of steroids. The steroids resulted in AVN. Last
year I went to a new pain management doctor and when she took a full medical
history she became convinced I had CD. Turns out I did. Within 2 months
of of going GFCF every bit of corneal rejection and iritis/uveitis was gone.
It doesn't bear thinking about how different my life would be
today if just one of the gastroenterologists and rheumatologists I have seen
over the last 4 decades had just even thought to test for CD (I had all the
typical GI symptoms) Sherene in Norfolk, VA
========
This actually is an issue I've discussed with my doctor. It's a
risk-benefit thing, like so much else in life: losing bone vs. making bone
more brittle by keeping what's there, but interfering with the remodeling
cycle. Neither thing is good, but keeping what you have has great benefits.
Osteoporosis, in sum, is a really bad problem to which there is, as yet, no
good solution.
Mary B NYC
==========
...when I broke my shoulder, both my md and chiro told me to take TWIN LABS
TRI=BORON PLUS....cal/mag with boron and vit D for absorption. Afterwards I
had surgery on my foot and was off my feet for almost a year. Before, my
bone density test was a plus 1.75 [very good]. A year of being off my feet
and taking Tri-Boron plus, my bone density went UP to plus 2. I told my gp
about it and he took his other patient off fosomax and put them on tri-boron
plus. No side effects, either Ann
==========
There was an article in the New York Times in the last six months or so
regarding treatment for osteoporosis and it included anecdotal accounts of
women on Fosamax and related drugs for a long
time (I don't remember the number of years) who broke bones in response to
minor trauma such as the bumpy ride on NYC subways. The statements of your
dentist provide a much clearer, though still anecdotal, account of the
problem. To me, it is just common sense that if a drug stops the bones from
remodeling, and you need remodeling to maintain the strength of the bone,
then there is a big problem with the biphosphanates (sp?). I am just
reading a book by John Abramson MD entitled, Overdosed America, The Broken
Promise of American Medicine. In this book, the
author briefly reviews osteoporosis research. According to his review, the
published data fail to support the conclusions of the biphosphanates
(Actonel & Fosamax) providing a substantial benefit in terms of preventing
fractures. He also points out a study which demonstrates that BMD accounts
for only 1/6 of the risk for fractures and that there are other much more
effective things you can do, such as exercise, which have been empirically
shown to provide a much greater reduction in hip fracture. The following is
a long quote (pages 213-215):
"...Randomized clinical trials of Fosamax published in medical journals show
dramatic reductions in the relative risk of hip fracture for women with
osteoporosis. In a study published in JAMA in 1998, for example, women with
an average age of 68 and a T score of -2.5 or less who took Fosamax for four
years were 56 percent less likely to suffer a hip fracture than women in the
control group.
"This sounds like very good news for women with osteopososis, but how many
hip fractures were really prevented? With no drug therapy at all, women
with osteoporosis had a 99.5 percent chance of making it through each year
without a hip fracture--pretty good odds. With drug therapy, their odds
improved to 99.8 percent. In other words, taking the drugs decreased their
risk of hip fracture from 0.5 percent per year to 0.2 percent per year.
This tiny decrease in absolute risk translates into the study's reported 56
percent reduction in relative risk. The bottom line is that 81 women with
osteoporosis have to take Fosamax for 4.2 years, at a cost of more than
$300,000 to prevent one hip fracture... A study published in the NEJM in
2001 showed that even women with
severe osteoporosis (T scores of lower than -4, or lower than -3 with a
major risk factor for hip fracture) derived only small bbenefit from these
drugs. The study randomized women between the ages of 70 and 79 to receive
Actonel (brand name of risedronate, cousin of Fosamax) or a placebo for
three years. Hip fractures were significantly reduced only in the women who
already had a spine fracture when the study began (40 percent of the women
in the study). One hundred such women would have to take Actonel for about
one year to prevent one hip fracture. For the other 60 percent of women in
the study without a preexisting spine fracture, Actonel did not signicantly
reduce the risk of hip fracture. Moreover, the drug appeared to have no
beneficial effect on their
overall health. There was no difference in the number of serious illnesses
(causing death or hospitalization), including fractures, that occurred in
the women who took Actonel compared with those who took the placebo. The
same result was found in younger women, with an average
age of 69, who had been diagnosed with osteoporosis and at least one spinal
fracture: fewer fractures but no reduction in the occurrence of serious
illness in the women who took Actonel. The net effect of drug treatment on
the risk of serious illness in the highest risk women?
Nothing--except the cost of the drug. ...the reality is that two out of
three hip fractures occur in women who have reached the age of 80. With 90
percent of hip fractures resulting from falls, it makes sense that the
oldest and frailest women would be at the greatest risk... Do the
osteoporosis drugs protect these women from hip fractures? They don't
appear to. The study of Actonel published in NEJM in 2001 included 3880
women over the age of 80 who had been diagnosed with osteoporosis or wo had
at least one major risk factor for falls (approximately 80 percent of the
women in the study had osteoporosis).
"Treatment of these women with Actonel was reported in the article to have
'no effect on the incidence of hip fracture.' So it looks as though the
women who have by far the greatest risk of hip fracture, and for whom the
consequences of hip fracture are the most devastating, do not benefit from
the drugs that are sold to help women with osteoporosis.
"What about using these drugs to prevent osteopososis? Fosamax and Actonel
were approved by the FDA to treat women with osteopenia based on studies
that showed that they signigficantly increase the bone density of these
women. It is important to remember, however, that bone
density is only a surrogate end point: the real reason for taking these
drugs is to reduce fractures, and hip fractures in particular. The study of
Fosamax published in JAMA in 1998 (mentioned earlier) also included women
with osteopenia. Did Fosamax reduce their risk of fracture? The results
show that the risk of hip fractures actually went up 84 percent with Fosamax
treatment. (Even though this is a large increase in risk, the number of hip
fractures was low, so the difference did not reach
statistical significance.) The risk of wrist fractures increased by about 50
percent (that figure may be statistically significant--but this can't be
determined from the data as presented in the article)."
--end of quote.
Dr. Abramson goes on to discuss research results re: nondrug interventions,
which, as it turns out, provide a much greater reduction in fracture risk
than the anti-osteoporotic drugssuch as Fosamax.
Since it has become abundantly clear that the pharmaceutical industry is not
to be trusted and has a pattern of pushing drugs, claiming wonderful health
benefits, in order to make big bucks when these drugs are actually
dangerous--eg HRT, Vioxx, Celebrex--I see no reason at all to take the
biphosphanates unless you want to contribute to the coffers of Big Pharma or
want to damage your bones. Mary
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