Alternatives to Osteoporosis Drugs Bisphosphonates

Sep 3 2010 - 3:50pm
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One new study says the osteoporosis drugs bisphosphonates may double the risk of esophageal cancer, while another new study says this is not true. Given this conflicting information, and the fact that bisphosphonates are associated with serious side effects, some people may want to consider alternatives to these medications.

Problems with Bisphosphonates
Bisphosphonates, which include alendronate (Fosamax), pamidronate (Aredia), and zolendronate (Zometa), among others, are a common treatment for patients who have osteoporosis. These medications work by inhibiting the formation of osteoclasts, cells that break down bone. Bisphosphonates increase bone strength and can lead to a reduced risk of fracture within the first five years after starting the medication.

The most common side effect associated with bisphosphonates is stomach upset. These drugs are also known to cause esophageal inflammation, which can lead to erosions of the esophagus and, as a new study reports, increase the risk of esophageal cancer.

Other serious side effects associated with bisphosphonates include osteonecrosis (death of bone cells) of the jaw. This complication is usually seen in individuals who take IV doses of bisphosphonates and after individuals have had dental surgery that involves the jaw.

Bone, muscle, and joint pain are also associated with the use of bisphosphonates. In fact, the Food and Drug Administration (FDA) issued a warning in 2008 about this very complication, encouraging healthcare professionals to evaluate such pain in their patients who are taking these drugs to determine if the medications should be discontinued.

Abnormal heart rhythm (atrial fibrillation) has also been reported, especially in elderly women who take the drugs. Unusual fractures of the femur have also been reported in some patients who have taken these osteoporosis drugs for several years.

Other Drugs for Osteoporosis
In June 2010, the Food and Drug Administration approved denosumab (Prolia), a fully human monoclonal antibody for treatment of postmenopausal women who have a high risk for osteoporotic fractures. It is given via injection every six months. The drug works by suppressing the turnover of bone, which may contribute to the possibility of osteonecrosis of the jaw. Common side effects include pain in the extremities and back, high cholesterol, and urinary bladder infections.

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Calcitonin-salmon (Miacalcin) is a synthetic version of the body’s natural hormone, calcitonin, which is produced by the thyroid gland. Calcitonin inhibits bone removal by osteoclasts and promotes bone formation by osteoblasts. It is available via nasal spray and injection.

Natural Alternatives for Bone Health
Natural ways to promote bone health may not offer the same degree of protection against bone loss or the possibility of fracture, but they are also free of the aforementioned side effects. These alternatives also require women (and men) to possibly make some lifestyle changes, although they are all beneficial in more ways than one.

One alternative is diet. Key bone-building nutrients include calcium, vitamin D, vitamin K, phosphorus, and magnesium, but others are important as well: chromium, zinc, manganese, copper, boron, potassium, strontium, silica, and vitamins A, C, B6, B12, and folic acid. Vitamin D, in particular, has been shown to reduce fractures as much as osteoporosis drug therapies, and it is also a nutrient that is deficient in most people.

A diet rich in fresh foods and that avoids processed foods, refined sugars, white flours, and soft drinks is a good basic foundation for bone health. Basically, this is an alkaline-forming diet (as opposed to an acid-forming one) and is commonly recommended for good bone health. Alkaline foods include fruits and vegetables (especially root vegetables), nuts, and seeds.

Regular, weight-bearing exercise and strength training are both important for stronger bones. Along with daily brisk walks, strength training with light weights or exercise bands should be done several times a week. Exercise should also be fun, so activities such as yoga, tai chi, swimming, and tennis should be included regularly when possible.

Stress management is instrumental in bone health, as cortisol, the main stress hormone, can be damaging to bones if it remains at high levels for a prolonged time. Daily attention to reducing stress, be it exercise, meditation, yoga, or just engaging in pleasurable hobbies, is encouraged.

Deciding whether to take bisphosphonates is a decision that should be made after discussion with an individual’s physician. Patients who have osteoporosis or who are at risk of bone loss need to take some action to preserve and protect their bones. For some individuals, that action may not require the use of bisphosphonates, but it should at least involve the natural alternatives mentioned, as well as recommendations from one’s physician regarding other osteoporosis drugs.

SOURCES:
British Medical Journal
Food and Drug Administration

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