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Doctors suggest that women hit pause button on osteoporosis drugs

Many patients have taken medications that include bisphosphonates for years. Doctors are debating how long people should take them. Recent studies point to health risks and problems linked to long-term use.

November 08, 2010|By Shari Roan, Los Angeles Times



In the last few years, evidence has emerged that long-term use of osteoporosis drugs — particularly the oldest class of drugs, the bisphosphonates — may do more harm than good. Some doctors are starting to tell at least some of their patients to stop taking the drugs for a time — in other words, to take a "drug holiday."






In rare cases, people taking bisphosphonates — which include Fosamax, Boniva, Actonel and Reclast — can develop jaw necrosis, a condition in which the jawbone begins to deteriorate. And a study published in September in the British Medical Journal found that people who take bisphosphonate drugs for several years have a slightly higher risk of developing esophageal cancer.

Experts don't know why the drugs would increase the cancer risk, although they are known to irritate the esophagus in some people.


Without a lot of clear scientific evidence to guide them, doctors are debating how long people should take bisphosphonates and whether occasional "drug holidays" are a good idea.

Bones grow and change. After reaching peak bone mass in the early or mid-20s, bone density begins to decline because old bone is lost faster than new bone is made. This process speeds up in midlife, especially after menopause in women.


Drug holidays may also be justified, these specialists say, because bisphosphonate medications remain in bone tissue for a year or two after people stop taking them. A study in 2006 followed postmenopausal women who took Fosamax for five years, at which point half of the women stopped taking the drugs and half continued. At the end of the 10-year period, there was no difference in fracture rates among the two groups.

"To give high doses indefinitely is not what you want to do," said Dr. Ian Reid, an endocrinologist and bone expert at the University of Auckland in New Zealand. "After five years, it's a good time to reassess. If the bones don't show osteoporosis, we typically stop the drug and monitor bone density. If they still have osteoporosis readings or have had a fracture, we keep them on medications for out to 10 years."

People who still have osteoporosis also have the option of switching to a different class of drug. One is the parathyroid hormone drug teriparatide (sold under the brand name Forteo), which, unlike the bisphosphonates, works by actively building bone. Another is the new medication denosumab (brand name Prolia), which is in a drug class known as the RANK ligand inhibitors. As the name suggests, it suppresses bone breakdown by inactivating a protein called the RANK ligand. It's too early to tell if long-term Prolia use causes some of the same side effects as bisphosphonates.

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