Monday, April 23, 2007
In 1999 my grandmother Esther had a bad fall in which she broke several ribs and suffered compression fractures in her spine. Her doctor subsequently diagnosed her with osteoporosis and prescribed Fosamax. But Grandma, then in her late 80s, had difficulty staying upright the required amount of time after taking it and complained the bisphosphonate medication left her nauseated. Worst of all, she didn’t like its hefty price tag, since back then Medicare had no prescription drug benefit.
So she quit – unilaterally, without even checking with the doctor. When my father found out she wasn’t complying, he tried to get her back on, but the second go-around didn’t last much longer than the first. By 2002 she was done with Fosamax for good.
My grandmother’s experience serves as a textbook example of how not to handle one’s medication regimen. Unfortunately, the scenario is all too common, and studies have shown bisphosphonate medications have poor rates of compliance – which of course can reduce the effectiveness of the medicine.
Bisphosphonates, including Fosamax, Boniva and Actonel, work by inhibiting the body’s natural process of bone breakdown, known as bone resorption. Essentially, the medication affects the body’s osteoclasts, cells which dig out portions of older bone. However, many patients complain about the medication’s requirements of staying upright for half an hour after taking it while not eating or drinking anything but water. Potential side effects include not just nausea, but also heartburn, irritation of the esophagus and other gastrointestinal problems. As a result many users of bisphosphonates are eager to quit at the first available opportunity. According to a recent study in the journal Drugs & Aging, approximately 20 to 30 percent of patients taking daily or weekly treatments may suspend them within 6 to 12 months of beginning therapy. The research also indicated that 12 to 18 percent of patients reported not complying with at least one rule while taking the drug.
But for some individuals who dutifully take their prescribed medication, their very compliance might eventually bring them some relief from the unpleasantness of the bisphosphonate regimen. A “medication holiday” can be just what the doctor ordered, according to Dr. Felicia Cosman, who is Clinical Director of the National Osteoporosis Foundation. Cosman says she views a course of bisphosphonate medication as a five-year plan. At that point, “it is reasonable to stop the medication,” she says, for patients who have demonstrated marked improvement in bone density and show no other risk factors.
Cosman, who is also Medical Director of the Clinical Research Center at Helen Hayes Hospital in West Haverstraw, N.Y., emphasizes that it is crucial that a patient remain closely monitored during the break, in case of any backsliding in terms of bone density. “You can always restart the medicine,” said Cosman, stressing that such patients should “optimize nutritional factors” by eating a varied diet including fruits and vegetables, supplement with calcium and vitamin D as appropriate, and cut out smoking and excessive drinking.
So she quit – unilaterally, without even checking with the doctor. When my father found out she wasn’t complying, he tried to get her back on, but the second go-around didn’t last much longer than the first. By 2002 she was done with Fosamax for good.
My grandmother’s experience serves as a textbook example of how not to handle one’s medication regimen. Unfortunately, the scenario is all too common, and studies have shown bisphosphonate medications have poor rates of compliance – which of course can reduce the effectiveness of the medicine.
Bisphosphonates, including Fosamax, Boniva and Actonel, work by inhibiting the body’s natural process of bone breakdown, known as bone resorption. Essentially, the medication affects the body’s osteoclasts, cells which dig out portions of older bone. However, many patients complain about the medication’s requirements of staying upright for half an hour after taking it while not eating or drinking anything but water. Potential side effects include not just nausea, but also heartburn, irritation of the esophagus and other gastrointestinal problems. As a result many users of bisphosphonates are eager to quit at the first available opportunity. According to a recent study in the journal Drugs & Aging, approximately 20 to 30 percent of patients taking daily or weekly treatments may suspend them within 6 to 12 months of beginning therapy. The research also indicated that 12 to 18 percent of patients reported not complying with at least one rule while taking the drug.
But for some individuals who dutifully take their prescribed medication, their very compliance might eventually bring them some relief from the unpleasantness of the bisphosphonate regimen. A “medication holiday” can be just what the doctor ordered, according to Dr. Felicia Cosman, who is Clinical Director of the National Osteoporosis Foundation. Cosman says she views a course of bisphosphonate medication as a five-year plan. At that point, “it is reasonable to stop the medication,” she says, for patients who have demonstrated marked improvement in bone density and show no other risk factors.
Cosman, who is also Medical Director of the Clinical Research Center at Helen Hayes Hospital in West Haverstraw, N.Y., emphasizes that it is crucial that a patient remain closely monitored during the break, in case of any backsliding in terms of bone density. “You can always restart the medicine,” said Cosman, stressing that such patients should “optimize nutritional factors” by eating a varied diet including fruits and vegetables, supplement with calcium and vitamin D as appropriate, and cut out smoking and excessive drinking.
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