Bisphosphonates for Osteoporosis: Safe for Long Term Use?

Are you taking a bisphosphate medication such as Fosamax or Actonel for osteoporosis? Bisphosphonates have become a popular treatment for this common bone disease that affects so many post-menopausal women (and some men). Up until now, many doctors have kept women on bisphophonates for osteoporosis for long periods of time, but new medical research shows that this may not be beneficial and could even lead to additional bone related problems.

How Do Bisphosphonates for Osteoporosis Work?

These medications work by attaching themselves to bone tissue where they’re taken up by osteoclasts – cells that normally break down bone during natural bone turnover. This causes the osteoclasts to be destroyed so that less future bone will be broken down. Because these medications attach to the bone and remain there, there may not be additional benefit to taking them long-term – in fact, it may be harmful.

How Could Taking Bisphosphonates for Osteoporosis Be Harmful Long-Term?

According to information published in Prescriber’s Letter, these medications slow down the rate with which bone is broken down and replaced. This allows small areas of microdamage gained from every day wear and tear on the bones to build up and go unrepaired. These tiny micro breaks in the bone accumulate over time leading to loss of bone integrity.

How Long is It Safe to Stay on Bisphosphonates for Osteoporosis?

The new literature suggests that if you’re at low risk for bone fractures, you may not need to be on bisphosphanates for longer than five years. At this point, your doctor could follow you with bone density studies to make sure you’re not losing additional bone mass. If so, you could be placed back on the medication. This wouldn’t apply to women at high risk of bone fracture who may need to stay on the medication longer term.

Keep in mind these are medications that build up in the bone and it’s unclear what long-term effects this could have on bone function. Five years should allow enough time for most women at low risk for bone fractures to get the benefits of bisphophonates without the harmful effects.

The Bottom Line?

If you’re taking a bisphosphanate medication to treat osteoporosis, talk to your doctor about your risk of developing bone fractures. If it’s low and you’ve been on a bisphophonate for at least five years, it may be appropriate to stop the medications and have bone density studies done every two years to make sure your bone density isn’t declining. Of course you should always consult with your doctor. Don’t stop these medications without your doctor’s knowledge.