Concern arose when case reports linked unusual femur fractures to people who have been taking one of these osteoporosis medications for more than 5 years. The story questions their long-term safety. The femur is the largest bone in our body, and fractures are usually caused by major trauma such as automobile accidents. The cases reported a fracture resulted from little or no trauma.

Bisphosphonates have shown to reduce fracture rates in people with osteoporosis by 50-70%. The unanswered question that remains is why people are sustaining these unusual fractures. Does the medication act differently in some people? Is the duration of being on a bisphosphonate the problem? Does medication have no relationship to the fractures? The answer to these very good questions is that we just don’t know.

The FDA has responded to the report.  Their stance is that there has been no confirmation that bisphosphonates leads to an increase in femur fractures. It is true that case reports are not strong science, so we cannot infer a cause/effect relationship. However, we also cannot ignore the occurences. 

As with every medical decision, your personal management depends on your individual situation. No medication should be started without first assessing its risks and benefits. 

So what should you do? As you all know by now, I strongly believe that science is the foundation of good medical care. However, we don't have scientific support for every decision to be made. Many decisions in 2010 must be made by intuition and evidence currently available. Perhaps hard science will be available in the future.

Call me if you have been on Fosamax, Actonel, or Boniva for more than 3 years. The case report showed that problems occurred after people have been on a bisphosphonate for more than 5 years. Until more information is revealed, I will suggest you consider a "drug holiday" after 3-5 years of treatment unless your osteoporosis is severe. For others we will reassess everyone's need for osteopenia/osteoporosis treatment at your next wellness evaluation. Bisphosphonates are believed to act long after you stop taking them. 

The situation brings to mind a quote by Dr. Wolfgang Vogel who taught my pharmacology course at Jefferson. He taught us that, "every medicine is a potential poison." All must be respected, no matter how much benefit they provide.