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Bisphosphonates: Overprescribed?
Growing Market, Growing Popularity
The population is aging as baby boomers become older Americans. As a result, bisphosphonates such as Zometa, Fosamax, Aredia, Boniva, and Actonel have taken center stage as the cure for treatment and prevention of weakening bones (osteoporosis), especially in postmenopausal women. But some are concerned over the definition of osteoporosis, which could cause overprescription of these often long-term bone density treatments. In particular, though Fosamax is often prescribed for women with osteopenia (a milder form of osteoporosis that often goes undiagnosed and untreated), it actually does not help women with this condition. Women with osteopenia can treat themselves with diet and weight-bearing exercise - an attractive option given bisphosphonate side effects. However, doctors are still prescribing bisphosphonates to these women, especially given the confusion between osteopenia and osteoporosis.
How Bisphosphonates Work
Bisphosphonates mimic pyrophosphate, a salt manufactured by our body which is key in both metabolic and bone regeneration processes. They allow bones to gain mass by inhibiting bone resorption, but studies are now showing that this process may interrupt the natural balance gained by the body in bone generation, causing a backfire in which microfractures are unable to heal after trauma, such as that incurred during dental surgery. In addition, bisphosphonates do not actually stimulate bone growth - they simply outweigh bone loss. Hence, they do not prevent fractures in women with osteopenia and no previous fractures.
The Risks of Bisphosphonates
Bisphosphonates are available in intravenous and tablet forms. The drug has been linked to side effects such as osteonecrosis of the jaw, a condition in which traumatized bone tissue fails to heal and eventually dies. There is no cure for ONJ; a May 2006 study published in the Annals of Internal Medicine found that 94 percent of the cases of ONJ occurred in patients who took bisphosphonates intravenously. In addition, bisphosphonates have been linked to other side effects such as gastrointestinal distress, severe allergic reactions, bone pain and hot flashes. Patients who are taking non-steroidal anti-inflammatory drugs (NSAIDs) should tell their doctor before beginning bisphosphonates and talk to dentists before undergoing dental surgery, which could increase the risk of ONJ.






