There’s been some confusion lately concerning several popular osteoporosis medications. Whom should they be prescribed to? Women with mild bone loss, or only those with serious cases of osteoporosis?

And can these medications actually cause fractures if used for too long a period of time?

This disease, osteoporosis, is a big problem. Thirty million women suffer from the disease that results from loss of bone density, and can result in a serious, even life-threatening bone fracture.

But should osteoporosis medications be reserved only for those with the worst forms of the disease, or should those with just the beginning signs of it, start on drugs like Fosamax?

Miriam Feldman, who says, “I’m getting shorter and shorter and that’s a fact. I can’t do anything about it.”

And Louis Feldman, her husband, says, “I used to be 5’4 and now I am down to five feet.”

They have similar refrains because they both share not only the same name, but also the same disease- osteoporosis.

The good news is, there are effective medicines that not only preserve the bone density, but in fact increase it--the bisphosphanates.

These are Fosamax and Actonel, taken weekly, and Boniva, the newest one of the bunch, taken monthly.

But when should someone be placed on one of these drugs? When he or she gets full blown osteoporosis, as defined by a significant degree of bone loss on a bone density test, or when he or she has a lesser degree--a condition called osteopenia--the precursor to osteoporosis.

There’s concern that if used for too long a period of time, medicines like Fosamax can actually block the normal resorption of bone, and put the bone at risk for fractures.
But many experts disagree with this line of thinking.

“The earlier you can start the better it is.” Dr. Mone Zaidi, the director of the bone program at Mt. Sinai Medical Center, says yes, these drugs should be started at the first sign of osteoporosis—osteopenia. “I don’t believe that there is absolutely any evidence to suggest that these drugs can cause a great incidence of fractures.”

In other words, don’t blame the drugs for fractures, likely due to the disease they’re treating. Still, others argue the drugs should be reserved only for those with frank osteoporosis, when benefits are highest, and the risk of causing a fracture because of too long a period of use is minimized.

Dr. Zaidi disagrees, and says the drugs should not be withheld. “There is a 50% risk reduction in fractures in most patients across clinical studies and in post-fracture trials,” he says.

Because of the hint that a suppression of the normal so-called bone remodeling, some experts are suggesting that patients take a one year holiday after several years of use. Others are advocating against starting medication until there is very significant bone loss.

Louis praises the osteoporosis medication he’s been on. “I have not broken any bones. Fosamax is really is a wonder drug.”

For more information, go to

http://www.nof.org/

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