Bone Density Drugs
Another Reason not to take Bone Density Drugs
It has always been my opinion that the majority of women who take drugs to increase bone density do not need them. They are prescribed on the basis of comparing the bones of a woman who may be 50, 60 or even seventy years old to the bones of a 30 year old woman. What part of your body is as good as it was when you were 30? Anything lower than a “T”score of -2.5 and you are getting a prescription. Furthermore, these drugs are dangerous and have very serious side-effects when used long term.
Just last month the Food and Drug Association of the United States published a review in the New England Journal of Medicine warning physicians of all the side-effects of long-term use of these drugs. It went on to say that, if needed, they should only be taken for no more than 3 to 5 years and that for the majority of women they were prescribed needlessly to patients who were not actually at risk.
Drugs prescribed to increase bone density and prevent fractures are known as bisphosphonates and are prescribed under the following names; Fosamax, Actonel, Boniva, Prolia and Reclast. The FDA study even found that in some cases these drugs actually led to weaker bones and contributed to some very rare but serious side-effects. These included femur fractures, esophageal cancer and osteonecrosis of the jaw, a painful and disfiguring crumbling of the jaw bone.
The bone-density test which seems to be used excessively for all women should only be used for very tiny small-boned women who may be at risk. For the majority of women it is a useless test because of the fact that your bones are compared to the bones of a thirty year old. It is another useless test that involves a large amount of nuclear radiation that is overused by physicians. If your bone density is less than -2.5, expensive bisphosphonate drugs are prescribed for you to be taken for the rest of your life.
Just to give you an idea of how much radiation is used; one of my customers had a bone-density test in the morning and then proceeded with her friends to Buffalo for some cross-border shopping. When they arrived at the US border, they were surrounded by a large group of armed guards and ordered out of the car. The radiation from the test had transferred to the metal of the car and set off all kinds of alarms at the border. It took quite a while to get the whole matter resolved and for a group of ladies to settle down after having rifles pointed at them.
When the FDA performed its own systematic review of the effectiveness of the bisphosphonate drugs, they found little or no benefit after three to five years of use. This prompted them to caution physicians about how they prescribe these drugs and to get a better understanding of osteopenia, which is not a disease at all, but a term created by the pharmaceutical industry. The word osteopenia actually means pre osteoporosis. It means you do not have osteoporosis but you may get it sometime in the future. You might as well say pre-cancerous or pre-stroke to a healthy person.
Your bones are in a constant state of remodeling – dissolving microscopic bits of old bone, a process called resorption and rebuilding new bone. After the age of 30, a woman’s bones start to dissolve faster than they can be rebuilt but this is the normal aging process. Everything in our body must slowly deteriorate as we age until we finally enter the final phase of our life. You lose pigment in your hair and your skin as they both become thinner with age. Our bodies very slowly deteriorate as we get older and that is normal. In some cases, as women enter menopause their bones become more brittle and may fracture. For some women it may be important to take these drugs but for the majority of women, a small amount of weight-bearing exercise and a diet rich in calcium will do the job.
Every time you use the muscles of your body, you stimulate the growth of cells in your bones. The more you use those muscles, the more bone tissue you will grow and that process never stops even if you are 100 years of age. That is why you very rarely see men with osteoporosis. We have more muscle than our female counterparts and the use of this muscle all our lives stimulates bone growth and keep our bones more dense.
However, when you take the bone-density drugs they are incorporated into the newly formed bone and persist there for years and years. This process actually interferes with the normal cycle of bone formation and for that reason if you are taking one of these drugs and suffer a fracture, you must stop the drug or otherwise the fracture will not heal.
The FDA study showed that long after patients had stopped taking the bisphosphonates; in most cases the drugs were still present in their bones. Another good reason for those who really need the drug to take it for 3 to 5 years only and then stop.
In an accompanying article by Dr.Rosen and others, also published in the New England Journal of Medicine, it found that women who have a history of spinal fractures or who have an existing fracture may benefit from the long term use of these drugs. They also concluded that small-boned women with brittle bones and already diagnosed with osteoporosis are candidates for these drugs. This study also agrees with the FDA study conclusion; the majority of healthy women do not need bone-density drugs and could be at risk if they take them.
Health Canada has also reviewed the evidence and their conclusion is that bisphosphonates are linked to a “slightly increased risk” of rare atypical fractures of the femur bone. Health Canada also says that the benefits of prescribing bisphosphonates outweigh the risk of femur fractures but don’t you think that should be decided between a woman and her doctor and not Health Canada?
We used to live in a time in which you developed a symptom and you went to the doctor for a diagnosis. Today we are bombarded with a multitude of screening tests that are determined to find things wrong so that we can either be operated on or given drugs. At least now we are learning that these screening tests are overdone. Recently we have learned that the PSA test is useless and creates more harm than good. We do not need blood tests every 3 months because once every 5 years is good enough. There is too much over-testing for breast cancer and the over-use of pap tests has finally been reduced from annually, to bi-annually and eventually to occasionally. All of these things supposedly to prevent disease but in reality a means to generate dollars into the health care industry.
The bone density exam is just another one of these over-prescribed tests designed to enrich the pharmaceutical industry and something that should not be routine but only taken by those at serious risk.