How safe are the bisphosphonate medicines currently on the market?

There are many factors to consider when selecting interventions to reduce health risks related to osteoporosis. First, behavioral factors that increase risk for bone loss should be minimized, and if possible, eliminated in an effort to spare the remaining bone. Behavioral factors that increase risk for bone loss include smoking, poor diet and consumption of caffeinated beverages and sodas. Of course, genetic factors and factors such as gender, race and small body frame cannot be eliminated, but they must be taken into consideration when choosing bone-sparing interventions. One of the best non-pharmacologic interventions is strength training with weights, supported by a wealth of evidence, including data from the Baltimore Longitudinal Study of Aging. I strongly encourage anyone with a history of bone loss to invest in a session with an athletic trainer to determine a course of strength training that is best suited to meet your health needs. There are many pharmacologic interventions that are approved for use for the prevention and treatment of osteoporosis, the bisphosphonates being among them. All medication classes have therapeutic and adverse effects that have to be weighed, and these are best discussed with your physician. It is important to note that calcium has never been shown to reduce fracture risk, and bone benefits are not significant with long term use of this supplement. Calcium benefits are best when consumed in food sources versus in the form of a supplement. There is current debate about whether calcium supplements are linked to myocardial infarction, which seems to be of greater risk in those taking calcium supplements with adequate dietary calcium consumption. More data is needed to clarify this risk. Excess calcium intake may also precipitate out as kidney stones. Vitamin D is used to improve the absorption of calcium, and you should be tested to determine whether or not you have a vitamin D deficiency before taking this supplement. Vitamin D alone does not reduce fracture risk. Bisphosphonates have been received negatively by the dental community because of their documented risks for avascular osteonecrosis of the jaw (ONJ). This risk is minimal with low dosages used for the prevention of osteoporosis, but is greater with the higher dosages used intravenously for the treatment of stage 4 (metastatic) cancers, notably breast and prostate cancers. Research shows that people who develop bisphosphonate-induced ONJ typically have other risk factors as well, such as steroid use, a history of smoking or a history of cancer, risk factors that are known to diminish the quality of the bone. New research also suggests that there is genetic risk for this adverse drug event. If you do not have these risk factors, your risk for ONJ is negligible. Rarely, some users experience mid-shaft fractures of the femur with long-term use, but this risk is not nearly as significant as overall risk for osteoporotic fracture, which is what you are trying to prevent by taking these drugs. The most common side effects associated with bisphosphonates are hypocalcemia, hypophosphatemia, and erosive esophagitis. Some people experience musculoskeletal pain, which tends to be more commonly experienced and of greater severity with the higher dosed drugs used intravenously for cancer treatment. Risks associated with all of the drug families indicated for osteoporosis must be weighed against your risk for fracture. Remember: fracture risk is the more important safety consideration. According to the National Osteoporosis Foundation, approximately one third of people with a hip fracture die within 1 year post-fracture. If a woman experiences a hip fracture, she is at a four-fold risk for a second hip fracture. Rate of hip fractures is two to three times higher in women than in men. A women's risk for hip fracture is equal to her combined risk of breast, uterine and ovarian cancer. And fractures can also occur in the spine, wrist and elsewhere. I hope that this information is helpful to you as you consider your options, and then discuss your concerns with your physician. Remember to have a bone density test after you adopt an intervention to ensure that the intervention is working for you. Maintaining bone health is an important investment in your future so that you can enjoy good overall health and function across your lifetime. Good luck!