Reconsidering Osteoporosis Drugs: Do They Have a Leg to Stand On?

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I’m sure you’ve seen one or more television ads for biphosphonate drugs such as Fosamax (alendronate) or Boniva (ibandronate) that picture healthy, vibrant midlife women selling you on the idea that you need a drug to ensure healthy bones for a lifetime. Would that life were that easy! Before taking or continuing to take one of these drugs, you need to know the full story. Then you can make a truly informed decision.

The first thing I want every woman to know is that your bones are designed to last a lifetime without drugs. Bone is, after all, a living, dynamic organ that constantly remodels itself through a process of resorption of old bone and laying down of new bone. And it’s completely normal to lose some bone around midlife. But that doesn’t mean you’re destined to get fractures. It’s your bone quality, not just bone density, that’s the issue here—and taking biphosphonate drugs puts your bone quality at risk.

The Untold Truth About Osteoporosis Drugs
The biphosphonates work by preventing bone resorption and loss. Inhibiting bone resorption secondarily inhibits the formation of new bone—and old bone is denser than new bone. It’s also more brittle than normal bone. So dense and hard, in fact, that it may be more difficult for this denser bone to maintain an adequate blood supply to ensure bone healing. Research on animals indicates that biphosphonates inhibit the normal repair of tiny fractures and porous bone (microdamage)—which eventually results in accumulation of microdamage and loss of bone strength. This explains why alendronate has been associated with delayed or absent fracture healing and also spontaneous, atraumatic, non-spinal fractures.
Worse yet, the biphosphonates are also associated with a very troublesome side effect known as osteonecrosis of the jaw—a side effect in which the jaw bone literally rots. Not only is this disfiguring, it’s very difficult to adequately treat. The biphosphonates have also been associated with the need for root canals and other dental problems. In fact, 60 percent of the cases of osteonecrosis of the jaw occur following dental surgery—probably secondary to the inability of this altered bone to heal itself.
Though it’s true that most cases of osteonecrosis of the jaw have occurred in cancer patients, it’s also been reported in healthy women. And this should be of great concern to everyone on the drug.

My Recommendations
Far too many doctors prescribe the newer bone-building drugs as a first line of treatment for any woman who shows any sign of decreased bone mass—even those who are very far from having osteoporosis. I cringe when I think that women are being treated with this one-size-fits-all mentality. The biphosphonates should not be given to relatively young midlife women for the prevention of possible osteoporosis. Plus, if you’re already on hormones of any kind, including progesterone, estrogen, or testosterone, there’s nothing to be gained by adding a biphosphonate. These hormones have already been shown to help maintain bone integrity.
There are many safe and effective alternatives that work more naturally with the wisdom of the body. (See box.) I’m very concerned about the long-term affects of today’s osteoporosis drugs. If you’re on a biphosphonate drug, limit the amount of time you’re on it, if at all possible.

Keep Your Bones Healthy for Life
Remember, it’s not the aging process per se that causes our bones to thin, it’s the fact that many women slow down and stop using their muscles. My 81-year-old mother has never had an osteoporotic fracture despite being hit hard on the wrist by a stray golf ball a couple years ago and also falling while hiking with a backpack last summer. (She had a huge bruise on her thigh, the impact was so big!) She’s been an avid exerciser all her life—she hiked 100 of the highest peaks along the Appalachian Trail over the age of sixty—and enjoys robust health on all levels today.
Last summer I met another role model here in Maine who lives alone on an island in the summer. She scales a cliff down to the sea every morning to bathe. When she stumbles and falls, she simply says the mantra “strong bones” and picks herself up again. Lois is 90!
Every woman—regardless of her bone density or bone quality—should be on the following bone health program:
Look for Role Models: Like my mom and my neighbor, there are many women living with strong, healthy bones well past menopause. Shore up your beliefs around this issue.
Take These Bone-Building Nutrients:
● Vitamin D: Get at least 1,000 IU per day. Some women need far more. To be sure, have your vitamin D blood level checked. It should be 52 ng/ml or higher. (Exposure to sunlight for 5-10 minutes in the early am or late afternoon over as much of your body as possible also increases vitamin D levels—in the Northern latitudes this must be between March 15 and October 15.)
● Calcium and Magnesium: Make sure to get both of these minerals daily. Calcium is ineffective when you don’t get enough magnesium. Get at least 1,000–1,500 mg of calcium and 400-800 mg magnesium per day.
● Multivitamins: Take a good multivitamin every day along with a mostly whole foods diet.
Exercise: Do weight-bearing exercises at least five days per week, this regimen can include yoga, walking, elliptical trainer, weight-training, and dancing. Make it fun!
Limit Your Alcohol Intake: Have no more than one to two drinks of alcohol per day.
Avoid Steroids if At All Possible.
Stop Smoking!!!

Christiane Northrup, M.D., a board-certified ob-gyn physician, is today’s leading expert on women’s health issues and author of three bestsellers, The Wisdom of Menopause, Mother-Daughter Wisdom, and the classic Women’s Bodies, Women’s Wisdom. The article above appeared in The Dr. Christiane Northrup Newsletter, available at www.drnorthrup.com.

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