New Danger to Women's Bones

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Bottom Line Newsletter...New Danger to Women's BonesMy friend has an aunt in her late 80s who is so stooped because of excessively thin bones that she can barely walk. So, when my friend had a bone density exam after menopause and it showed that her bones too were beginning to thin, she was understandably panicked. The doctor told her about the drug alendronate (Fosamax), one of the bisphosphonates developed to help prevent further bone loss and treat it. My friend happily signed herself up. She has been on Fosamax for six or seven years and she, along with her doctors, had assumed she would probably take the drug for life. Now, though, a startling study has cast long shadows on that assumption. DETERIORATING JAW BONES Salvatore Ruggiero, DMD, MD, chief of oral and maxillofacial surgery at Long Island Jewish Medical Center in New Hyde Park, New York, was astonished to see a rare condition develop with the jaw bone in a particular set of female patients... the condition, called osteonecrosis of the jaw (ONJ), is a condition that tends to occur after dental work that causes trauma to the jaw. Doctors often detect it when the jawbone becomes exposed and sometimes an infection has set in. ONJ had been associated with bisphosphonates before Fosamax, but previous to this, patients were those who had been administered bisphosphonates as IV treatment for cancer. What Dr. Ruggiero observed was ONJ had also developed in another group of patients who had undergone oral surgery at his hospital over a three-year period. These women were taking bisphosphonates orally for the treatment of osteoporosis. (Besides Fosamax, other bisphosphonates for osteoporosis include Boniva and Actonel.)I called Dr. Ruggiero to discuss what millions of women currently taking bisphosphonates should do in response to this finding. He stresses that while the Food and Drug Administration (FDA) now requires that drug manufacturers add labeling stating that ONJ is a potential side effect of bisphosphonates, the condition as associated with osteoporosis is extremely rare. Of the 159 ONJ patients from his medical center, just 25 had taken the medication orally and the overall percentage of women on oral bisphosphonates who develop ONJ is much smaller than that -- well under 1% of all patients, he says. That said, there are those who theorize, including Daily Health News contributing editor Andrew L. Rubman, ND, that ONJ is just the first sign of a broader bone deterioration problem. He explains that the long-term survival of bone is dependant on ongoing activity of both bone formation by osteoblast cells and bone resorption (removal or breakdown of micro-damaged or old bone) by osteoclast cells. Inhibiting osteoclast function with bisphosphonates has the effect of slowing and eventually stopping the other over time, says Dr. Rubman. Risk ONJ or spend elderly years with dead bones? STEPS TO TAKE Prior to this disclosure, the main reported side effects of bisphosphonates were a bevy of gastrointestinal problems. As long as women's "tummies didn't rumble" they saw no reason to suspend use of the medication. Besides, ibandronate (Boniva), a newer bisphosphonate drug that requires taking just once a month rather than daily or weekly, as with Fosamax, seemed to help with GI side effects. However, Dr. Ruggiero feels it is time to rethink the length of time osteoporosis patients are allowed to stay on any of these drugs. He anticipates that the next step may be to have "drug holidays" in which women go off the medication for several years at a time, and then return to it for the same period before suspending its use once again. Women would need to be monitored in this period for any bone deterioration with bone density scans... and they must also be careful to continue vigilance about protecting their bone strength in more traditional ways, such as taking their calcium and Vitamin D, exercising regularly, limiting alcohol and not smoking. ONJ AND DENTAL CARE Dr. Ruggiero is extremely concerned about some of the over-reaction he is seeing among patients who are shying away from routine dental care and even among dentists who are reluctant to treat this group of patients. He stresses that routine dental care is not likely to open the gates to ONJ -- it is bone that was once traumatized that fails to heal properly that causes the problem... for example, work that involves trauma to the jaw including extractions and implants. Furthermore, he says it is critical for all women on bisphosphonates to get regular careful dental care. That is how they can be sure their teeth will stay strong so they will not end up needing extractions or implants. He says for those women who do have to have dental work that will involve jaw bone healing, information to date shows that there is nothing to worry about if they have been on oral bisphosphonates for up to five years. The exception: For those patients taking steroids and a bisphosphonate, the time frame is much less, or as little as two years. For those who have taken them longer, he suggests going off the medication for at least a few months before elective dental work. Even though these drugs stay in the bones for an extremely long time, he says that a year off them does seem to make ONJ more manageable -- assuming that normal bone cell function can be restored and metabolically supported, based on the ebb and flow of bone cell formation and resorption. TELLTALE SIGNS OF ONJSymptoms of ONJ are pain and/or numbness in the jaw, swelling, loosened teeth, gum infections and exposure of bone within the oral cavity. Women who experience any of those should see their doctor right away. Dr. Ruggiero says not to be alarmed about the possibility that problems like this could develop in other bones in the body, from bisphosphonates. To date, there has been no reports of this complication occurring anywhere other than the jaw, he added. Dr. Rubman feels somewhat otherwise, given that maintaining the drug is necessary to maintain any bone density gains and the fact that studies have yet to be done to show the effects of discontinuing the drug and the ability of the natural bone turnover process to restart itself. Thus he fears that we may be creating bone that lacks vitality and survivability over time. Dr. Rubman is a strong proponent of doing everything possible to support healthy bone density. **** I discovered a mineral called 'Strontium' that acutally builds the boneswithout the side effects of Fosamax...You can find it at Supplements, Etc.on the internet. Their new website is under construction but their phone numberis there. And...This product is recommended by Dr. Jonathan Wright