Bone experts are rethinking the way they treat osteoporosis now that research has linked widely prescribed drugs to rare but serious leg fractures.
Bisphosphonates, a class of drugs that are highly beneficial in reducing bone fractures in people with osteoporosis, the experts say, should not be prescribed to patients who don't have the disease but are at risk of developing it, as often has been the practice in recent years.
And osteoporosis patients should talk to their doctors about taking a "holiday" from the drugs after two or three years on the medications, says Ken Lyles, director of geriatrics research at Duke University. The drugs can be taken intermittently after several years, he says.
"This is a change, absolutely," says Lyles, a member of the American Society of Bone and Mineral Research. "I look at it as a positive thing. We're learning more. We have good drugs, but we need to know how to use them correctly."
Lyles and Douglas Kiel, a professor at Harvard University and ASBMR member, will discuss the subject at this weekend's annual conference of the American Geriatrics Society.
Osteoporosisis is a major health threat for the aging population. An estimated 10 million Americans have the disease, and almost 34 million have low bone mass, putting them at risk for spine and hip fractures. Women are more likely to be affected than men.
Bisphosphonates (Fosamax, Reclast, Actonel, Boniva) are among the top-selling drugs in the country. Annual sales exceed $3.5 billion, according to IMS Health, a research firm that tracks prescriptions. The Food and Drug Administration in November warned about potential risks of atypical femur fractures when taking the drugs, and a Swedish study last week in The New England Journal of Medicine called for "intermittent use" because of a reduced risk of fracture after taking a break from the drugs.
Osteopenia, a condition marked by lower-than-normal bone mass, is regarded by some physicians as a precursor to osteoporosis. Kiel says the drugs are unnecessary for osteopenia unless there are other factors that could lead to fractures, including a history of falls, low body mass index, smoking and excessive drinking.
"These atypical fractures are substantially less frequent than other fractures," Lyles says, "so we have to be careful not to throw out the baby with the bath water. If a person is diagnosed with osteopororis and it's decided they should be treated with bisphosphonates, they should try the medications."
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