Running an Unnecessary Risk of Fracture

Summarized by Robert W. Griffith, MD February 5, 2007 Summary People with osteoporosis are poor compliers in taking their prescribed medication, and even those that start off correctly often drop out later .

[Sue]

Its very difficult to be compliant with these medications, when they cause such side effects. i.e.
stomach upset, severe joint and bone pain, and now
the possibility of jaw osteonecrosis. Perhaps
the medical drs can explain to the patient, the benefits (if any), but what the real truth is
about the side effects. Yes, osteoporosis is
a serious condition, but are the side effects worse
than the condition???

[Peter Mandel]

I am a physician. First, Evista is not in anyway associated with osteonecrosis of the jaw (ONJ). ONJ is a rare complication associate with use of Biphoshonate medications such as Fosamax and Actonel. The estimated incidence of ONJ is one case per 100,000 years of patient use. Second, unfortunately most medications have side effects. However, the vast majority of patients who take Evista, Fosamax or Actonel do not experience side effects. You should certainly express your concerns to your doctor. The correct medicine depends on a number of factors including your past medical hstory, your degree of bone loss, your fracture risk (which is more than just bone loss, it includes age and factors that may predispose you to falls),your nutritional status, lifestyle factors such as smoking and exercise. Hip and vertebral fractures are very serious and lead to both death and suffering including deformity, loss of moblility, loss of independence, compromised pulmonary fuction. I treat a large number of women with osteopenia and osteoporosis. If you have bone loss I also suggest that you get checked for vitamin D defficiency. Have your doctor order a 25 Hydroxyvitamin D level to check. I do this routinuely and find significant numbers of patients who are deffiecent. Hope this info help[s and good luck.

[Sue]

Peter Mandel wrote:

I am a physician. First, Evista is not in anyway associated with osteonecrosis of the jaw (ONJ). ONJ is a rare complication associate with use of Biphoshonate medications such as Fosamax and Actonel. The estimated incidence of ONJ is one case per 100,000 years of patient use. Second, unfortunately most medications have side effects. However, the vast majority of patients who take Evista, Fosamax or Actonel do not experience side effects. You should certainly express your concerns to your doctor. The correct medicine depends on a number of factors including your past medical hstory, your degree of bone loss, your fracture risk (which is more than just bone loss, it includes age and factors that may predispose you to falls),your nutritional status, lifestyle factors such as smoking and exercise. Hip and vertebral fractures are very serious and lead to both death and suffering including deformity, loss of moblility, loss of independence, compromised pulmonary fuction. I treat a large number of women with osteopenia and osteoporosis. If you have bone loss I also suggest that you get checked for vitamin D defficiency. Have your doctor order a 25 Hydroxyvitamin D level to check. I do this routinuely and find significant numbers of patients who are deffiecent. Hope this info help[s and good luck.

Thank you for the information Dr. I had an early menopause at age 38 and did not take HRT. I am now 57. Therefore my osteoporosis is quite severe. I took
Actenol for 3 years, and my hip area woresened.
The dr could not explain this. I was then seen by
an endocrinologist who checked my PTH, and Vitamin
D levels, all were normal. I do not take calcium
supplements due to 4 bouts of kidney stones. I get my calcium thru dairy products. I started Fosamax
and was nearly crippled with knee pain, neck pain,
vertigo and tinnitus. I also developed TMJ and
my dentist will no longer treat me if I stayed on
Fosamax. NOW WHAT??? I dont know, but I am very
scared. I do not have any fractures, no lost in height, but am very slim (5'2") and 111 lbs. I
exercise 60 minutes EVERY day. I am trying my best,
but feel as though I am up against a brick wall

[Peter Mandel]

Early menopause (unless of course it was secondary to surger) is sometimes associated with autoimmune diseases such as lupus. Since you suffer from knee and neck pain, you should be evaluated for autoimmune disease. As far as your dentist is concerned, his position is irrational since even the ADA doesn't advise taking osteoporetic patients off biphosphonates (ie fosamax). You did not mention what your t-scores were or if you had any vertebral fractures (this can and should be asertained with your bone density test by obtaining a lateral view called a vertebral fracture risk assessment or VFA). Severe osteoporosis, t-scores less than -3.0 or occult verberal fractues put you at very high risk for future fracture and should be treated aggressively. For such patients I generally recommend Forteo. How ever, you need to be evaluated by a qualified physician. Additionally, if you are a risk for calcium kidney stones, calcium citrate (ie citracal), does not appear to increase your risk of kidney stones.

[Sue]

Thank you for your response. My early menopause
is genetic,as both my mother and aunts had the same. I have been evaluated for autoimmune disease, pagets disease. I failed to mention I smoked for almost 15 years, and quit 5 years ago.
I have been evaluated for fractures and there are none. My T score in my hip is a -6. I did have
a 2.9% increase in spine and forearm. I did speak to endocrinologist about Forteo, but he was even
a little leary about prescribing it, and my insurance will not cover the high cost. I will
look into starting Citrical. As far as the knee and neck pain, they have diminished since I stopped
the osteoporosis drugs. Thank you for your input.

[eva]

Peter Mandel wrote:

Early menopause (unless of course it was secondary to surger) is sometimes associated with autoimmune diseases such as lupus. Since you suffer from knee and neck pain, you should be evaluated for autoimmune disease. As far as your dentist is concerned, his position is irrational since even the ADA doesn't advise taking osteoporetic patients off biphosphonates (ie fosamax). You did not mention what your t-scores were or if you had any vertebral fractures (this can and should be asertained with your bone density test by obtaining a lateral view called a vertebral fracture risk assessment or VFA). Severe osteoporosis, t-scores less than -3.0 or occult verberal fractues put you at very high risk for future fracture and should be treated aggressively. For such patients I generally recommend Forteo. How ever, you need to be evaluated by a qualified physician. Additionally, if you are a risk for calcium kidney stones, calcium citrate (ie citracal), does not appear to increase your risk of kidney stones.

Peter - I am 40, had surgical menopause last year due to the BRCA mutation (prophylactic salpingo-ooph, but intact uterus), and was diagnosed with osteopenia through DEXA last May. I had a follow up DEXA 2 weeks ago, and my scores have worsened, but not to osteoporosis. I am not comfortable taking bisphosphonates, due to FH HX severe GERD, and raloxiphene has been recommended. Are there long-term (over 10 year) studies confirming safety; what about the finding of increased ovca (my mother had both breast and ovarian cancer); and does evista change the bone remodeling process like bisphosphonates? Many questions, I know. I would prefer to give it another year, really focus on an absurdly healthy diet and solid exercise and calcium/Vit. D supplementation, and then repeat the DEXA to see if the bone loss has stabilized. Is that irrational thinking? Thanks.

[Mary]

I am a 44 year old woman with severe osteoporosis [T scores (-)3.1 and (-)2.5]. My boyfriend would like to teach me how to waterski. I am sure that in the process of learning, I will fall multiple times. I am concerned about my fracture risk. Do you think this is something I should avoid or is it OK to go ahead and do this?

[ray]

Mary wrote:

I am a 44 year old woman with severe osteoporosis [T scores (-)3.1 and (-)2.5]. My boyfriend would like to teach me how to waterski. I am sure that in the process of learning, I will fall multiple times. I am concerned about my fracture risk. Do you think this is something I should avoid or is it OK to go ahead and do this?

I sure wouldn't try to waterski with those numbers. Mine are that bad also, and I have broken more bones in the last few years than in my whole lifetime. Most just from a simple fall.

[Mary]

Thanks Ray, that's very helpful!

[Harold E]

My response to Peter M. I am a dentist with a wife facing oversuppression secondary to bisphosphonate use. To keep you up to date, a recent CEU stated that dentist need to be cautious in treating any patient that has been on oral bisphosphonates for greater than 3 years. Recommendation is to have a CTx done and based on the values adjust treatment accordingly. Discussion with a local oral surgeon last night yielded the insight that the problem with ONJ is far greater than what is being disclosed.

[Sue]

Finally a dentist who is willing to disclose
what we have all been concerned about. Thank you
for your post! My dentist will NOT treat anyone
women who has been on these drugs unless he has
a full consultation with them and what the
consequences may be if a root canal or extraction
was needed. Thank you!!!

[Quality of life wrote]

ray wrote:

<quoted text>
I sure wouldn't try to waterski with those numbers. Mine are that bad also, and I have broken more bones in the last few years than in my whole lifetime. Most just from a simple fall.

RAY. Are you on fosamax or actonel? If you are on those drugs for a couple of years, you can have broken bones by simple everyday movements like walking, standing etc due to an oversuppression (frozen bones (which means bones seem to be thicker but in fact more brittle))

read here:
http://jcem.endojournals.org/cgi/reprint/90/3...

I strongly advice everyone to go back to the good old calcitonin nasal spray (30 yrs of safety record!). Latest research shows that it also helps on the hip which was up untill now the only disadvantage of calcitonin. Further on it helps with the pain too ...

[Ellen]

I just started reading everyone's comments. Also have just started (today) Evista. I've just been diagnosed with osteoporosis. Have gotten worse these past 2 years. Am 63 yrs old, very active and outdoorsy. Ride horses, etc. Change during the past 2 years? Pretty much quite exercising and taking calcium. I tried Actonel (once) and got so sick. Everything hurt and I won't ever take that pill again. Now I'm trying Evista. Is it possible to not take these pills and simply starting a good exercise and nutrition program which of course includes calcium and vitamin D? So many times we read about these so-called wonder drugs causing more harm than good.

[Scared by Big Pharma]

OK folks lets remember one important thing here:
the bone density machines were designed BY THE DRUG COMPANIES and use numbers to compare us to a 16 year old girl. WE ARE NOT 16 anymore! These tests are designed to make us fail!!
I would recommend more vitamin d, calcium and magnesium, exercise and BioSil or other similar product.
I know someone (age 61)who refused to take the poisions (farce-a-max, bone-eater)and did all of the above and her bone density numbers actually went up! The Dr.s office actually called her to tell her they didn't understand how or why( guess drs. don't know that much about how our bodies work anymore, do they?) but even without the "miracle drugs" she had improved.
FLUSH all those BIG PHARMA poisions down the toilet.
RARE=most people when it comes to side effects.
My sister took this crap for about 5 years. Within short time of being on it she had heart palpitations. Then developed chrohns disease.
Now she finally stopped as worried about teeth..she has minor gum issues.
BUT the damage is already done. The 1/2 life of these drugs is long so even being on for a year causes a lot of damage.
The new studies say the bones ARE NOT getting stronger...just look thicker and are actually MORE brittle thanks to these great drugs.
HOW MUCH longer before they are pulled from the market?? I predicted back when Farce-a-max started running their propaganda campaigns that these drugs would cause more harm than good?
hmmmmm
Also my mom had eye issues while taking this crap. I couldn't convince her until too late to stop taking them. They caused her a lot of bone and back pain too. Of course words of wisdom from Dr...oh that will stop shortly. Yeah...well it didn't but her eyes (a known side effect) got damaged. Then it was her heart.
I wouldn't give this stuff to my pets!
How many more Vioxx incidents are we going to allow our drs. and BIG PHARMA to push us into?
How many more innocents will suffer? IS your dr. going to come and spoon feed you your food every day when your jaw is gone?