Osteoporosis Medication Concerns

by Dr. Sandy | Comments

Reader Question: My doctor wants me to take an osteoporosis medication, but I heard these might cause jaw and heart problems. Isn't that more dangerous than weak bones?

First of all, weak bones are more serious than you might realize. Having osteoporosis means you're much more likely to fracture or break your bones, which can be painful and debilitating. That's why I still recommend that most of my patients with this condition continue to take medication for it—however, there are some risks you should know about.

There are many types of osteoporosis medications, but the most popular are those in the bisphosphonate class. These include Actonel, Boniva and Fosamax. Unfortunately, a recent study found that about 4% of people who use these meds experience a breakdown of the jaw bone (osteonecrosis). Another study, from the Archives of Internal Medicine, found that people who use Fosamax were nearly twice as likely to suffer from a heart rhythm abnormality called atrial fibrillation—but we don't know if there's a cause/effect relationship. Most recently, The New England Journal of Medicine reported that 23 people taking Fosamax developed esophageal cancer over the last eight years—but again, we don't know whether the drug actually caused this problem. Still, people with a condition called Barrett's esophagus (which can be a precursor to esophageal cancer) should not take any of the bisphosphonates until this is further clarified.

The benefits of these drugs outweigh the negatives for most people, but you should talk to your doctor and go over your personal health history before deciding what's right for you. You might also consider another type of medication—such as hormone therapy or a drug like Evista (raloxifene), which belongs to family of medications called SERMs (selective estrogen receptor modulators). Raloxifene has an added benefit in that it can help prevent breast cancer. The downside is that it may increase the risk of blood clots and can also cause hot flashes—so there's a lot to think about.

Whether or not you end up taking any medication for osteoporosis, make sure you're getting enough calcium (1,200 to 1,500 mg daily). However, if you take a supplement, do NOT take it at the same time of day as an osteoporosis medication, or the calcium could interfere with the drug's absorption. You'll also want to make sure you're getting enough vitamin D; I tell my patients to take a supplement of vitamin D3 (cholecalciferol), 1,000 IU daily. It's a good idea to have your vitamin D level checked (with a simple blood test) to make sure you are getting enough. Another tip? Get moving! Weight-bearing exercise stimulates new bone formation.

