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You Should Take Your Bisphosphonate Medication For How Long And Why?

How long should you take your bisphosphonate medication? There may be an increased risk and fewer health benefits after five years of taking Fosamax, Reclast or Actonel.

There is growing evidence that in addition to the risk of a serious bone disease of the jaw (osteonecrosis), the risk of atypical fractures of the thighbone also increases with the use of bisphosphonate medications.

In addition to Fosamax, this group of medication includes Actonel (risedronate), Boniva (ibandronate), Atelvia (risedronate delayed release), Didronel (etidronate), Skelid (tiludronate) and Reclast (zoledronic acid injection).

The U.S. Food & Drug Administration (FDA) has asked manufacturers to add warnings to their labels about the risk of atypical thigh fractures which are breaks that occur spontaneously, in the course of normal activities, such as walking down stairs.

A study released in May, 2012 in the Archives of Internal Medicine adds further support to this growing concern. In this study of 477 people, 82% of those with atypical fractures were taking bisphosphonates while only 6.4% of patients who had a classic femur fracture were on this group of medication.

The FDA looked at three long-term studies to determine whether the medications continue to deliver any benefits after five years of treatment:

  • Fosamax Fracture Intervention Trial Long-Term Extension (FLEX)
  • Reclast Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly-Pivotal Fracture Trial (HORIZON-PFT) extension
  • Actonel Vertebral Efficacy with Risedronate Therapy – Multinational Trial (VERT-MN) extension

These studies indicate that the prescription medication helps to reduce fractures for approximately five years, but after this period fractures increased.

People who continued to take the medication for six years or more had fracture rates of 9.3-10.6% compared to 8.0-8.8% for those who switched to an inactive placebo.

What Should You Do?

People need to discuss with their doctors the duration of their medication relative to their T-scores. A bone density score (T-score) below -1.0 means you have low bone density and anything under -2.5 is considered osteoporosis.

Long-term bisphosphonate use may be appropriate for people with:

  • T-scores below 12.5 (osteoporosis) at the femoral neck of the hip after taking medication for three to five years
  • existing spine fractures and T-scores below -2.0

People with femoral neck T-scores above -2.0 who are at low risk for spine fracture are not likely to benefit from extended use.

Vitamins And Minerals Can Support Bone Health

There is extensive research supporting the use of generic vitamins and minerals to support bone health without side effects and at minimal cost.

It is essential to maintain optimal vitamin D blood levels to support calcium absorption. Magnesium helps to improve bone quality. In Japan, vitamin K2 has been used for decades to help push calcium into the bones.

Many have also found that strontium citrate helps to increase bone density as much as prescription medication without the side effects.

People concerned about the risks of long-term use of osteoporosis drugs may find that vitamins and minerals provide an attractive alternative to bisphosphonate medication.