Fractures After Prescription Drugs for Osteoporosis

Recently, a good deal of attention has been directed at unusual fractures after bisphosphonate use. Bisphosphonates are a class of prescription drugs used to treat osteoporosis.   This, in addition to other reports of side effects to the jaw, has left some patients wondering if bisphosphonates are worth the risk?

A few years back, a disturbing new fracture started showing up in our emergency departments among osteoporotic patients – an atypical femoral fracture.  A typical hip fracture among elderly patients with osteoporosis is a break at the top of the femur (thigh bone). But this new fracture appears in the shaft of the femur - between the hip and knee - giving the underlying bone an unusual or atypical appearance.  And unlike normal hip fractures, a majority of patients reported many weeks and even months of dull thigh or knee pain before the fracture.  In addition, most patients described actually feeling their bone break and then falling.  All of these symptoms and the appearance of the bone point to these new fractures being very similar to stress fractures. In a stress fracture, muscles become fatigued and transfer the overload of stress to the bone, causing a tiny crack.

Bone is a dynamic, living structure that is under constant change.  Imagine a bridge that has a construction crew on-site at all times. When the bridge breaks a cable, the crew springs into action! They remove the broken cable and repair the bridge.  Your bone is very similar.  It is under constant reconstruction and responds to stress by laying down more bone.  This process relies on a balance between tearing bone down and building it back up.  With osteoporosis, the breaking down happens faster than the building up.

Bisphosphonates may help modify this process.  They work by stopping the break down of bone.  When you stop the break down of bone you also affect the dynamic nature of bone.  The net result of treatment with bisphosphonates is an increase in bone mineral density because the breaking down of bone is stopped.  So, the real question is:  just because the bone is heavier, is it better?

The answer to that is complicated.  Bisphosphonates have reduced overall fracture rates, but the long-term consequences of shutting down bone turnover are not very well understood.  Taking the bridge analogy one step further…is a heavier bridge a stronger bridge?  If the workers try and fix the broken cable without removing the old one, can the bridge stay structurally strong?

Bone is constantly suffering small injury and repairing it. The inability for bone to repair these small injuries can progress to a larger problem – a stress fracture - and ultimately may lead to a complete fracture.

These atypical fractures absolutely heal more slowly than a standard hip fracture.  Thankfully with our modern implants and good nutritional support, we can usually get the bone to heal.  Having the right nutrients, those in Silical® Boost, provide a better environment for bone healing.

In spite of these concerns, the benefits of bisphosphonates outweigh the disadvantages for those with full-blown osteoporosis. However, for those with low bone density who have not had a fracture, there is still time to begin a bone health program of exercise, diet, and Silical® System* that may reduce the risk of osteoporosis.

*Adequate calcium and vitamin D, throughout life, as part of a well-balanced diet, may reduce the risk of osteoporosis.

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