While mild bone density loss is a natural part of growing older, the progression of osteopenia to osteoporosis can have serious implications on your quality of life. Weakened by a loss of mineral content, osteoporotic bones are brittle with a sponge-like internal structure that is slow to heal in the event of a fracture. Due to the significant risks associated with this level of fragility, doctors often recommend treatment with prescription drugs for patients with a diagnosis of osteoporosis. Unfortunately, these drugs are not without risks of their own.
Bisphosphonates, the most common class of drugs to treat this bone disease, work by slowing the rate of bone loss, allowing your body the opportunity to rebuild healthy bone tissue. This is a slow process, but improvement is often seen over the course of a typical 5 year treatment course.
At the same time, recent studies have indicated that these medications can increase your risk of esophageal cancer and two different types of uncommon fragile bone conditions: atypical femoral fractures and osteonecrosis of the jaw. Atypical femoral fractures (AFFs) occur when the femur, or thigh bone, suddenly breaks as a result of the accumulation of small stress fractures inside the bone over time. Osteonecrosis of the jaw (ONJ) is an often painful condition which occurs when there is a loss of blood to the jawbone, most often after a tooth extraction. The risks of these serious adverse events have caused many individuals to interrupt their treatment or abruptly stop taking bisphosphonates entirely.
In addition, studies have indicated that there may be limited benefit to taking bisphosphonates beyond the normal treatment duration of 5 years. A study known as the Fracture Intervention Trial (FIT) found that while those who took bisphosphonates for an additional 3 years had stronger bones in the hip and spine, those taking a placebo did not experience a dramatic decline in their bone density. Rather, the effects of bisphosphonates seemed to persist for years after ending treatment.
Despite the potential risks, the FDA has determined that the benefits of bisphosphonates outweigh the adverse events associated with them. The agency considers these medications as safe, effective, and well-tolerated. However, if you or a family member have already been diagnosed with osteoporosis, it is best to be informed about all positives and negatives of any new medications and to discuss any concerns you might have with your doctor.
