Most Postmenopausal Women Can Discontinue Use of Osteoporosis Drug with No Risk

A recent study published in the Journal of the American Medical Association (“Effects of Continuing or Stopping Alendronate After Five Years of Treatment,” JAMA, December 27, 2006) suggests that women who discontinue taking alendronate after five years of treatment do not significantly increase their fracture risk for up to an additional five years. Women who discontinued the alendronate treatment had the same rate of non-spine fractures as women who continued using the drug. However, the study also finds that women at very high risk of spine fractures may benefit by continuing to take alendronate beyond the initial five years.

Prior to this study, it had not been known whether treatment of osteoporosis should be continued indefinitely. These findings are especially welcome for older post-menopausal women taking multiple drugs for a variety of conditions.

Alendronate - the most widely used osteoporosis drug - reduces bone loss, increases bone density, and reduces the risk of spine, wrist and hip fractures, and is approved by the FDA for both prevention and treatment of osteoporosis in postmenopausal women and for the treatment of osteoporosis in men. Alendronate belongs to a class of drugs called bisphosphonates, all of which are antiresorptive medications. Antiresorptives slow the part of the bone remodeling cycle in which old bone is removed (bone resorption).

The long – term study on the use of alendronate among postmenopausal women in 10 clinical centers around the U.S. was led by researchers from the University of California, San Francisco. The new findings are from a follow-up study to the initial trial that examined the effect of a daily dose of alendronate on bone mineral density and fracture risk in postmenopausal women with low bone mineral density for up to 3.8 years.

Ask the Expert

I have been taking medication for gastroesophageal reflux disease (GERD), and I just read an article that said this medicine can result in bone loss and even fractures. How concerned should I be?

In December 2006, a study was featured in the Journal of the American Medical Association (JAMA) that showed a possible connection between certain acid suppression medications and an increased risk of hip fracture. Additional research is needed to confirm these findings. The medications in this study are in a class of drugs called proton pump inhibitors (PPI) that include Nexium®, Prevacid® and Prilosec®. They are used to treat conditions such as heartburn and acid reflux disease.

The association between the PPI drugs and hip fracture risk appears to be an issue only for those people who are on relatively high doses, equivalent to 40 mg or more a day, when they are used for a long period of time. Those patients who occasionally use over-the-counter or even prescription doses should not be concerned.

Talk to Your Doctor First Before Stopping Your Medication

Many People take these medications for serious medical conditions. These drugs are important for people with major health problems, but they are not for everyone. Patients should be prescribed the lowest effective dose available to treat their condition(s). People concerned about taking these medications should speak with their healthcare provider about whether they need to continue using the medications.

Ask Your Healthcare Provider if You Need a Bone Mineral Density Test

Long-term use of the PPI drugs may be a risk factor for osteoporosis and bone fractures. If you are on high doses of these drugs long-term, speak with your healthcare provider about whether you should have a bone mineral density test.

Calcium Needs

To maintain bone health, adults need a nutritionally balanced diet which includes calcium-rich foods. It is especially important for people on these medications to obtain a daily calcium intake of at least 1,200 mg. Additionally, some people taking PPI drugs may need a bit more calcium, but they should not exceed a daily intake of more than 1,500 mg a day. When people obtain some or all of their calcium needs by taking supplements, they need to make sure to take their calcium supplements with meals for good absorption. The exception is calcium citrate supplements, which are well-absorbed when taken with or without food.

Bone Healthy Behaviors

Experts recommend a daily intake of between 800 and 1,000 international units (IU) of vitamin D for most people age 50 and older. Some people will need even more. People under 50 should get a daily vitamin D intake of between 400 and 800 IU. Appropriate regular exercise helps maintain bone density. To protect your bones, it is important to avoid drinking excessive amounts of alcohol and smoking cigarettes.

Abstract of the Study

You may view the abstract of the study reported in JAMA by visiting this Web page: http://jama.ama-assn.org/cgi/content/abstract/296/24/2947.