Amid osteoporosis treatment crisis, experts suggest addressing patients' bisphosphonate concerns

Bisphosphonate drugs effectively slash the risk of hip and spine fractures due to osteoporosis; however, in a small population of patients, they may actually cause debilitating injuries.

Bisphosphonate drugs effectively slash the risk of hip and spine fractures due to osteoporosis; however, in a small population of patients, they may actually cause debilitating injuries. Rather than occurring as the result of falls or other trauma, atypical femur fractures can strike an older adult who is doing something as simple as walking or even standing still. Although even more rare than atypical femur fractures, osteonecrosis of the jaw can also affect people taking bisphosphonates. The threat of snapped femurs and crumbling jaws, and the long road to recovery, is enough to deter some patients—no matter how low the risk—from taking bisphosphonates. NIH data reveal a more than 50% drop in oral bisphosphonate use from 2008–12 in women aged 55 years and older. However, research suggests that failing to use the drugs to treat osteoporosis can produce poor outcomes, too. By some estimates, treating 1,000 women with bisphosphonates for 3 years might result in 1.25 atypical femur fractures but might avert roughly 100 osteoporotic fractures. With many older women not receiving necessary treatment—and risking a future of physical impairment or early death—specialists are seeking the best way to address concerns about bisphosphonates. It may help to educate patients, for instance, that the drugs are prescribed only for those at high risk for fractures—which eliminates much of the previous overtreatment—and that they are no longer prescribed for an indefinite period. In fact, the American Society for Bone Mineral Research suggests considering drug holidays for patients who have taken bisphosphonates for 3–5 years. Other approaches include monitoring bisphosphonate users, taking action based on patient reports of thigh or groin pain, and results from dual-energy x-ray absorptiometry machines that test bone mineral density.