Comment on New York Times article entitled “Bone drugs shunned for fear of side effects”

A recent New York Times article entitled “Bone drugs shunned for fear of side effects”, is an excellent article written by the well known medical writer Gina Kolata. This is important information for all of my patients whether they are already at the age where bone loss and risk of osteoporotic fracture is present or, if considerably younger, concerns about bone health for themselves or their loved ones should be still on their minds going forward.

By way of background statistics: more women in the United States will suffer and a serious fracture of hip or spine than all of the heart attacks, strokes, breast cancers, and gynecologic cancers COMBINED.Truly a staggering statistic!

Bone health and the risk of fracture from loss of bone after menopause is an important personal as well as a public health issue. It is said that a 50-year-old woman who doesn’t already have cancer or heart disease has a life expectancy of 91!! In the past when women didn’t live as long as they do now bone health and the concerns for us to prevent fracture were not as great in generations years ago. Thus maintaining bone health throughout one’s lifetime is crucial.

It begins with what I call FAMS ( Flexibility Agility Mobility and Strength). There should be a lifelong adequate calcium ingestion ( preferably in one’s diet, rather than supplements) but also supplementation of 1000 to 2000 IU’s of Vitamin D per day. At the appropriate interval after menopause baseline Bone Density testing (DEXA scan) should be performed. Finally, it is tragic that so many women who WOULD benefit from drug therapy to reduce the risk of fracture shy away from appropriate therapy because of fear of very VERY rare side effects including the osteonecrosis of the jaw( abbreviated ONJ) and these atypical fractures of the femur which are exceedingly rare. As this article points out you only need to treat 50 people to prevent one osteoporotic fracture while fewer than one in 10,000 women on medication would be expected to have either the problem in the jaw (ONJ) or an atypical fractures. Women who do sustain a hip fracture have a 25% chance of not surviving one more year and a 20% chance of ending up in assisted-living. Another staggering statistic!

Obviously decisions about whether or not medications are appropriate, and if so, which are the best medications for any individual patient, must be made on a case-by-case basis. As I’ve told so many of you: guidelines are created for populations medicine should be practiced one patient at a time. If you have any concerns about your bone health or one of your relative’s bone health, feel free to contact our office.

Dr Steven R. Goldstein is a past President of the International Menopause Society, a Certified Menopause Practitioner and a Menopause Specialist in NYC.