Consumer Reports Insights: How to reduce the risk of falls and fractures

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Tuesday, May 11, 2010

What if a drug that you've been taking for five years to prevent fractures was actually found to cause them?

That may be a concern for women who use popular osteoporosis drugs including alendronate (Fosamax and its generic equivalent), ibandronate (Boniva), risedronate (Actonel) and zoledronic acid (Reclast).

Prompted by media reports questioning the safety of such drugs, known as bisphosphonates, the Food and Drug Administration issued an alert in March about an ongoing safety review of them.

A delicate dance has ensued between the FDA and Merck, the manufacturer of Fosamax, which issued a statement about the safety of its drug.

Despite the FDA's announcement that there is "no clear connection" between the osteoporosis drugs and femur fracture, the FDA urged health-care professionals to be aware of this potential risk.

Physicians may believe that Fosamax's potential to reduce risks of hip or spine fractures probably outweighs a possible risk of femur fractures, but there are other reasons to adopt a cautious approach with this and other bone-building drugs.

Consumer Reports has long advised that Fosamax, Boniva and other drugs in this class offer only modest benefits in building bone and preventing fractures. And they pose some risks: throat or chest pain, difficulty swallowing and heartburn. More rare but serious and long-lasting adverse effects include abnormal heart rhythm (atrial fibrillation); incapacitating bone, joint and muscle pain; and bone loss in the jaw.

But when you consider that many doctors prescribe bisphosphonates not just for people with outright osteoporosis but also for those with osteopenia, or "pre-osteoporosis," those concerns take on an added urgency. That's because it's not as clear that the drugs are effective for this less serious but much more common condition. (It affects, for example, more than half of all white, pre-menopausal women in the United States.)

Bottom line: If you are diagnosed with osteopenia, Consumer Reports' medical consultants strongly advise that non-drug measures be used to reduce bone loss instead of a bisphosphonate drug. Taking supplemental calcium and Vitamin D can strengthen bones, as can walking, dancing and other weight-bearing aerobic activities. Those exercises also build muscle and improve balance, both of which can help prevent falls that cause fractures.

You can further reduce the risk of falls by limiting how much alcohol you drink, avoiding sleeping pills and by fall-proofing your home by doing such things as keeping extension cords out of the way, installing grab bars in the bathroom and rubber mats in the bathtub or shower, and getting rid of loose rugs.

For those with osteoporosis who already take Fosamax, Boniva or other bisphosphonates drugs, consider taking a "drug holiday" after five years' use. The rationale: Because the drug remains active in your system for such a long time once you stop using it, taking more of it may be unnecessary, unless your doctor determines that your bone loss has become rampant.

Copyright 2010. Consumers

Union of United States Inc.

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