There is new evidence linking risk for one kind of fracture with long-term use of bisphosphonates -- drugs like Fosamax that are prescribed to treat osteoporosis in older persons by increasing bone density in order to prevent fractures.
The findings are reported by Drs. Dean G. Lorich and Joseph M. Lane of NewYork-Presbyterian Hospital/Weill Cornell Medical Center in the latest issue of the Journal of Orthopaedic Trauma.
"While bisphosphonates like Fosamax have been proven to successfully treat osteoporosis and other metabolic bone disease, we believe long-term use of these drugs may suppress the ability of bones to heal in some patients. As a consequence, patients with routine stress fractures are unable to properly heal, and minor damage can worsen until a serious fracture occurs," says Dr. Lorich, the study's senior author. He is assistant professor of orthopaedic surgery at Weill Cornell Medical College and associate director of orthopaedic trauma surgery at NewYork-Presbyterian/Weill Cornell and the Hospital for Special Surgery.
The preliminary study followed 70 patients, 25 of whom were taking alendronate (Fosamax) for an average of five years. Among those receiving the therapy, 19 patients (76 percent) presented with one type of femoral stress fracture (simple, transverse) that resulted from little or no trauma. By comparison, the fracture type was only evident in one patient (2 percent) not receiving the therapy.
Furthermore, the average duration of alendronate use in those patients with the fracture pattern was significantly longer than in those who were not taking the therapy, at 6.9 years versus 2.5 years, respectively.
"While more research is necessary to confirm our results, physicians prescribing bisphosphonates for longer durations should monitor patients for indications of bone regeneration. In situations where a blood test reveals low bone turnover, a holiday from the bisphosphonates would be recommended until these markers return to an acceptable level," says Dr. Lane, the study's corresponding author. He is professor of orthopaedic surgery at Weill Cornell Medical College and an orthopaedic surgeon at NewYork-Presbyterian/Weill Cornell and the Hospital for Special Surgery.