Osteoporosis

An article on the front page of the New York Times was entitled “FDA is Wary of Lengthy Use of Bone Drugs”. Many of my patients or else members of their family may be taking medication to help reduce osteoporotic fracture. Some of these women are on drugs mentioned in this article and other women are not. Such information may be confusing and frightening to many patients and so I believe it is worthy of discussion in this space.

In the first place, realize that osteoporotic fractures are one of the most serious health concerns that women and all of my patients face as we progress through the 21st Century. A 50 year old woman who does not already have cancer or heart disease has a life expectancy of 91. Thus, concerns about fracture as women get older are greater than ever before. Currently, there are 1,000,000 osteoporotic fractures in women in this country per year. That is more than all of the heart attacks, strokes, breast cancers, and gynecologic cancers combined. Twenty five percent of women who fracture their hip will be dead within 1 year. Twenty percent of women who fracture their hip will never live independently alone again. Make no mistake about it: reducing the risk of osteoporotic fractures in women at high risk is essential.

One of the problems is that many physicians have started to treat patients’ “T-scores” from their bone density tests rather than truly assessing fracture risk. Thus, many women who are not at high enough risk for fracture (a term previously referred to as “osteopenia”) have in fact been started on many of these drugs. I am the Co-Director of the Bone Density Laboratory here at NYU and have lectured extensively and write the update each year for a journal called OBG Management on Osteoporosis. I’ve tried to teach other gynecologists how to appropriate evaluate and treat patients for bone health. Clearly there is a very small incidence of unusual side effects associated with long term use of the bisphosphonates (Fosamax, Boniva, Actonel, Atelvia, Reclast). These include atypical fractures of the femur and osteonecrosis of the jaw (although this dental problem is almost never seen in women who have not received intravenous medication and who do not already have cancer or suppression of their immune system). I reiterate that these serious complications are extremely rare. The FDA published cautions, but they did not change any of the recommendations relative to use of any of these medications. Patients who have established osteoporosis should be maintained on these medications although some women after 5 years can in fact take a “drug holiday”. These concerns to not apply to the bone health drugs Evista or Prolia. These are a different category of drug and are not the ones covered by this article on the FDA announcement.

As always, if you have any concerns about your bone health or someone in your family, please give me a call or stop by for a consultation.