The First 48 Hours: Osteoporosis Medications

When Michelle Easton, 56, was diagnosed with osteoporosis five years ago, her doctor prescribed Fosamax. Michelle was diligent about taking the pill every week - and remaining upright for the required time afterward without eating or drinking anything other than water - but over the next few years, her bone density decreased further. But Michelle, who lives in the Virginia suburbs of Washington D.C., faithfully continues her regimen and the bone loss has finally stabilized.

"It's a bit of a bother, but before I know it, the hour is gone," says Michelle, who takes the weekly medicine on a Saturday or Sunday so she will have time to shower and dress leisurely before eating breakfast at the allowed time. The inconvenience is worth it, she says, because her osteoporosis might be even worse without the medication.

The first 48 hours after being diagnosed with osteoporosis can be a stressful time, especially if your physician brings up prescribing medication. Many osteoporosis medicines, especially bisphosphonates - such as Fosamax (alendronate), Boniva (ibandronate) and Actonel (risedrontate) - are as well-known for their gastrointestinal side effects as for their bone-building potential.

 

"It's a very individual thing," says Dr. Linda F. Bach, who specializes in internal medicine and has a family practice in Miami Shores, Fla. "A lot of people, no matter how bad you tell them their osteoporosis is, don't want to take any medicines."

Bisphosphonates, which many doctors consider the first line of defense against osteoporosis, work by suppressing or inhibiting the body's natural process of bone breakdown, known as bone resorption. The medicine leads to the apoptosis, or cell death, of the body's osteoclasts, which normally dig out portions of older bone. This allows the balance to swing toward the osteoblasts, which build bone.

For many patients, a primary drawback of bisphosphonates is the requirement to take it first thing in the morning, remaining upright for at least 30 minutes afterwards, and not consuming anything but water. Potential side effects include nausea, heartburn, irritation of the esophagus and other gastrointestinal problems - especially for those who don't follow the instructions closely.

In addition, there has been some controversy over the association of these medicines with a condition known as osteonecrosis of the jaw, or dead bone tissue. Symptoms of this side effect can include toothache, loose teeth, jaw pain, recurrent infections in the soft tissue and failure of the jaw to heal normally after a procedure such as an extraction. However, most bisphosphonate users who develop osteonecrosis of the jaw are those patients who take the medication intravenously at levels required to combat cancer.

For postmenopausal women unable to tolerate the side effects of bisphosphonates, many doctors prescribe Evista (raloxifene). This type of drug is called a Selective Estrogen Receptor Modulators or SERM because it has the same positive effects on the bone as estrogen while limiting its negative health effects on other parts of the body. However, the medicine is not recommended for anyone at risk of pulmonary embolism.