By now you’ve heard about the bisphosphonates that are typically prescribed when a woman or man experiences the bone-thinning disease of osteoporosis or osteopenia. They are known by their commercial names of Boniva, Fosamax, Actonel, Reclast and were introduced in the mid-1990s.

Introduced in the mid 1990s, a recent New England Journal of Medicine review questioned whether there is any bone strengthening to gain from long-term use of these medications past three to five years. Now another report released today, Monday, May 21, in the Archives of Internal Medicine is reporting on one of the complications of long-term use of bisphosphonates – unusual fractures of the thigh bone.

The study reports on 477 people hospitalized at one center, 39 had an atypical fracture with 438 experiencing a common fracture. Among those with an atypical fracture, 82% had been taking bisphosphonates compared to 6.4 % of those with the common fractures. An atypical femur fracture occurs just below the hip joint and in the long part of the thigh bone and these fractures are very uncommon – less than 1%of all hip and femur fractures.

The bottom line is that there hasn’t been much study of the risks of long-term use of bisphosphonates. While they appear to help in selected high-risk individuals, especially those who have already had a hip or spine fracture or with a low bone mineral density, the femur fractures and jaw necrosis that we are seeing in long-term users of four, five years or more may be just the beginning of the complications.

The FDA reviewed three major studies on bone health after long-term bisphosphonate use:

  • The Fosamax FLEX drug trial;
  • The Reclast HORIZON-PFT trial; and
  • The VERT-MN Actonel multinational trial.

All of these studies found that within five years, bisphosphonates did deliver on their promise of reducing the risk of fracture from brittle bones. But after that, the benefits appeared to taper off while the fracture rates increased.

Cornell University Medical School researchers in 2008 found those taking Fosamax had a more than 125 times the risk of suffering a non-traumatic femur fracture.

The head of the Harvard Women’s Health Watch says the article reminds us that only those who really need the drugs should be taking them. In other words if you have osteopenia or a thinning of the bone that is the precursor to osteoporosis – then make lifestyle changes including weight bearing exercise.

That could include aerobics; strength training the major muscle groups at least twice weekly; incorporating balance exercises such as tai chi or yoga at least twice a week and adding flexibility or stretching to your exercise regime.

According to the National Osteoporosis Foundation there are 10 million Americans suffering from brittle bones and 34 million with low bone density. And what may be surprising is that women are not the only ones impacted. Men represent 20 percent of those with osteoporosis.