Bisphosphonates treat osteoporosis

Dear Dr. Roach: I have had osteoporosis for a while and recently had a bone density test that again confirmed that I have it. I am not really interested in taking an oral prescription such as Fosamax, because of the many negative side effects. I would like to find out more about the injection, Prolia. I also understand that there is an infusion, Reclast, that is done once a year. I am concerned about the strength of something that is done only once a year and any side effects since I tend to be sensitive.

I have also heard that the bone that is produced after taking these medications tends to be brittle and breaks easily. If that is true, how is that helpful?

A nurse told me that her 88-year-old mother, who had been very active and healthy, just turned the wrong way and broke her back. She said that at 69 years old it isn’t a huge issue, but at 80 it may be. That is why I am considering a treatment plan currently.

D.B.

Answer: Osteoporosis is decreased bone mass, abnormal bone architecture and bone fragility. Having it puts men and women at higher risk of fracture.

Alendronate (Fosamax) is a type of medicine called a bisphosphonate. Zoledronic acid (Reclast) is an injectable form of the same class of medicine. It is certainly true that medicines like these have the potential for side effects. However, doing nothing is not a good choice. Without treatment or prevention, 15% of women and 5% of men will develop a hip fracture by age 80. Hip fractures have a profound effect on quality of life.

Long-term use of osteoporosis drugs can lead to brittle bones and atypical fractures. Experts can avoid this risk by using these medications appropriately, i.e., for only as long as necessary and by changing medications if needed. The long-term safety record of oral bisphosphonates like alendronate is well-established when used properly. It is the best first-line treatment for most men and women with osteoporosis.

Denosumab (Prolia) works similarly, but because the gains in bone strength are lost quickly after stopping Prolia, it’s not my first choice.