Question: Should I use Bisphosphonate (or strontium ranelate Protos or teriparatide or calcitonin, or tibolone) for my age-related Osteoporosis?
Answer: Don’t not unless you want your bones (osteonecrosis), gullet(cancer) or skin (toxoderma) to rot.
There is no evidence to support their longterm safety and efficacy and high cost..
Nor is there evidence of benefit to any other organ system.
EXPOSING THE BISPHOSPHONATE DECEPTION :
A new study published this New Year’s Day by University Arkansas confirms concerns about the dreaded osteonecrosis even from oral alendronate Fosomax even 10mg/day for 3 years in women between 40 and 60years of age. They found bizarre giant osteoclasts (which are undergoing protracted death) in bone biopsies of osteoporosis trialists, even after a year off alendronate -this effect increasing with cumulative dose… Shades of the cumulative effect of oral estrogen-progestin – it takes much more than 10 years on PremPro before the increase in breast cancer ibecomes apparent.
And in the same issue of the New England Journal of Medicine, the FDA reports some 50 cases from
USA, Europe & Japan of oesophageal cancer in patients on bisphosphonates (mostly Fosamax) , with 28% dying from the cancer. No such cases have even reached Pubmed listing.
It is bizarre to see quoted “However, most experts said that the incidence of esophageal cancer in patients taking Fosamax might not be high enough to warrant concern.” This for a class of drugs for which there has never been shown definite need in osteoporosis, nor longterm safety and benefit.. Did anyone ask the experts if they would take such drugs?
By contrast, a huge amount of evidence that this column has repeatedly reviewed the past year shows that no synthetic designer drugs are needed to prevent and treat even the worst ostoporosis of aging or from eg cortisone use- the dozen +- combined lowcost natural supplements do it all. They may do it slowly- but surely- in the highest risk patients (eg with severe osteoporosis from rheumatoid arthritis on cortisone and other remittive drugs and repeated surgery) only at a rate of improvement in low bone density of at worst about 2% a year in the spine and 1% a year in the hip neck – up to if not exceeding 16% In the hip, 26% in the spine after 15 years.
But at the same time the natural supplement basket does what no designer chronic drugs do – strengthen mood, upright stability, mind, immunity, Parkinson’s, circulation, muscle and not least bone. They thus speedily abolish osteoporotic fracture risk while lowering the incidence by at least 1/3 if not half of all major chronic degenerative diseases, as well as of all-cause premature mortality.
There is an interesting website (apparently by NHS Prescription Services ) that tabulates the monthly volumes used in England from Nov 2004 to July 2007 of the following:
Bisphosphonates up from 310 000 to 478 000;
Strontium ranelate up from 49 to 13 000;
And raloxifene down from 16 300 to 12 500.
So while bisphosphnate use rose by 50%, strontium Protos use rose from zero to about 2.6% of their joint market.- so far without any evidence of significant adversity. But then Protos has only been in use for some 6 years. The first cases of long bone osteonecrosis on bisphosphonate were first reported a dozen years ago, although bisphosphonates had already been in use for 30years. And it has taken over 40 years for increased isk of cancer from bisphosphonate to be noticed- in people at a mean age of about 73yrs..
Reporting to March 2008, the NHS reports that the crippling “hip or spine fractures have a lifelong risk in women of about 1 in 4”. and while only “20% of people with a hip fracture die within 6 months, 50% of patients with hip fracture cannot live independently.. . In the past 4 years, while spending has been reined back, the total prescriptions of antiosteoporosis drugs in England doubled; as did the market share of bisphosphonates; yet adherence to bisphosphonate treatment is often low”
Even in 1999 a major trial in young postmenopausal women in Demark showed that much benefit of bisphosphonate was lost if it was stopped after 2 years; whereas “Compared with 5 mg of alendronate per day, estrogen-medroxyprogesterone acetate (ie the regime used in the Women’s Health Initiative) produced similar increases in bone mineral density… and estradiol-norethisterone acetate NETA(as is commonly used longterm in Europe without adverse effect ) produced increases that were substantially greater.” Eg in the Oulu trial for 10 years, the ±69 women on E2-NETA had zero major chronic diseases and thus deaths.
By using appropriate HRT –especially including appropriate testosterone (the only true all-system anabolic) – via skin rather than orally via the gut, the dose of HRT is reduced 10 to 20fold to physiological doses and blood levels, with nothing but benefit across the board – even (with approriate other therapy) after breast cancer.
So since over 50 years of modern scientific experience with appropriate HRT in men and women (and monkeys) for up to >40years, (let alone the giant Womens’ Health Initiative for up to 8 years) show that appropriate estrogen started soon after menopause reduces all major chronic disease risks and deaths by 1/3, with similar experience with appropriate vigorous use all all other proven supplement combined-
– why use bisphosphonates or strontium (or eg a SERM, or teraparatide, or calcitonin) for aging osteoporosis except in long-term controlled trials against the gold standard natural supplements? Who is benefiting from the high cost of the designer drugs except the manufacturers, suppliers and the providers of the extra monitoring required? – certainly not the patient.