Flap’s Links and Comments for May 6th on 08:32

These are my links for May 6th from 08:32 to 08:45:

• What Will Be the Future for Long Time Fosamax Users? – While jumping rope with the neighborhood children, a 59 year old Queens, New York woman felt her thigh bone snap. The pain was so severe that she fell to the ground as she readied for another jump. Sandy Potter had been diagnosed at the age of 48 with osteoporosis and began taking the drug Fosamax. She further stated that she had been on the medication for eight years prior to the incident and was now informed that her femur had snapped into two separate pieces.

  Fosamax is a commonly described drug used in the treatment of osteoporosis and contains bisphosphonates, which is used to slow the loss of bone and increase bone mass. Concerns about some of the side effects of Fosamax have been increasing and now there is mounting evidence that for some women that have been taking Fosamax for more than five years could be in danger of having fractures that are spontaneous in nature.

  According to Dr. Kenneth Egol, a professor of orthopedic surgery at NYU Langone Medical Center, over the last 18 months, femur fractures, such as the one in Sandy Potter’s case are occurring with more frequency
  Many patients claim that they were engaged in a low-impact exercise when they suddenly experience a break in the femur. What concerns Dr. Egol, is that because the femur is known as one of the strongest bones in the body, it should not be sustaining the damage that it has. Yet, people taking a leisurely walk or walking down a flight of stairs is experiencing this type of injury. Dr. Egol further stated that upon reviewing the X-rays taken of some of his patients, the images take on the appearance of an injury endured by a car accident rather than a minimal fall.

• Dietary changes may preclude some prescriptions for osteoporosis, researchers say – While a number of prescription medications exist to reverse the bone loss associated with osteoporosis, a recent survey of medical literature indicated that many patients should first look into getting more calcium and vitamin D in their diets or through supplementation.

  Researchers from the University of Illinois at Urbana-Champaign stated as much in an article published in the journal Nutrients, where they noted that bisphosphonates may not rebuild the best sort of bone tissue, compared to adequate vitamins and nutrients in one's meals.

  In a meta-analysis of more than 200 research papers published in the prior 10 years, scientists found that the direction of medical inquiry has been increasingly swinging toward the initial use of calcium and vitamin D to treat osteoporosis.

  Co-author Karen Chapman-Novakofski said that a partial explanation for this trend appears to be the difference in bone quality between individuals on bisphosphonates and those eating a more complete diet or taking dietary supplements.

  "Bisphosphonates…disrupt normal bone remodeling by shutting down the osteoclasts – the cells that break down old bone to make new bone," she commented. "When that happens, new bone is built on top of old bone. Yes, your bone density is higher, but the bone's not always structurally sound."
  The National Osteoporosis Foundation states that bisphosphonates decrease the risk of hip fracture by up to 50 percent. However, the organization adds that some researchers have raised concerns that the drug class can occasionally lead to negative side effects, including thigh aches and broken femurs.By contrast, people over the age of 50 who take 1,200 milligrams of calcium and up to 1,000 international units of vitamin D each day may see gains in bone density with relatively few side effects, Chapman-Novakofski said.

• Osteoporosis Drugs, Bisphosphonates Increases the Risk of Fractures – According to a new study at Sweden, it has been disclosed that osteoporosis drugs known as bisphosphonates is linked to the infrequent bone fractures. However, the risk of the fractures from osteoporosis drugs is very small in contrast to their benefits.

  The bone-building drugs bisphosphonates includes Aclasta, Actonel, Aredia, Bondronat, Boniva, Didronel, Fosamax, Fosavance, Reclast, Skelid, and Zometa.

  A Study Researcher and Professor of Orthopaedic Surgery at Linkoping University, Sweden, Per Aspenberg, MD, and PhD said that the risks of these drugs are very rare if it is prescribed correctly.

  The study, which was published in the New England Journal of Medicine, has included 12,777 women aged 55 and older, who suffered a fracture of the thigh bone in 2008. The study found that osteoporosis drugs are associated with the higher risks of fractures. The association among the bone-building drugs and fractures is very weak.

• Bisphosphonate use and ?risk of atypical hip and ?femoral shaft fractures – Clinical question Do oral bisphosphonates increase the risk of atypical hip and femur fractures in postmenopausal women?

  Bottom line Oral bisphosphonate use for 5 years or longer is significantly associated with an increased risk of atypical hip and femur fractures (subtrochanteric or femoral shaft). A previous study (JAMA 2006;296:2927-2938) found little if any benefit of extended bisphosphonate use beyond 5 years in reducing the risk of typical fractures of the femoral neck or intertrochanteric region. Although this study design (case-control) is classified as weak evidence (LOE = 3b), it may be the best we have for some time. Thus, practicing clinicians should consider stopping bisphosphonates for most women after 5 years, except for those at high risk (eg, chronic steroid users). (LOE = 3b)

  Synopsis Current evidence on whether bisphosphonates increase the risk of subtrochanteric or femoral shaft fractures in postmenopausal women is uncertain. These investigators analyzed information obtained from multiple databases on the association between bisphosphonate use and fractures in a cohort of women in Ontario, Canada, 68 years or older, who initially started oral bisphosphonate (alendronate, risedronate, or etidronate) therapy between April 2002 and March 2008. Separate databases included information on drug prescriptions, hospitalizations, physician service claims, cancer, and basic demographic information. Cases included those women hospitalized with a subtrochanteric or femoral shaft fracture. Up to 5 women who were not hospitalized with similar fractures were matched to age and cohort entry date and served as control patients. Analyses were performed to adjust for other fracture risk factors. During the 7-year study period, 205,466 women commenced oral bisphosphonate therapy. Of these, 716 (0.35%) were hospitalized for an atypical subtrochanteric or femoral shaft fracture. The use of bisphosphonates for 5 years or longer, compared with transient or no use, was associated with a significantly increased risk of atypical hip or femur fracture (odds ratio [OR] = 2.74; 95% CI, 1.25-6.02). Among the 52,595 women using bisphosphonates for at least 5 years, a subtrochanteric or femoral shaft fracture occurred in 188 (0.36%) within 2 years. Duration of therapy of less than 5 years was not associated with an increased risk of fracture.

  Park-Wyllie LY, Mamdani MM, Juurlink DN, et al. Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. JAMA. 2011;305(8):783-789.