Five years of Fosamax and Friends is Enough, Says FDA

World Osteoporosis Day 20 October

Over two years ago I asked the rhetorical question, “When is enough Fosamax enough?”  Well, the FDA has finally given an answer, with their assessment of the risk of thigh-bone fracture associated with long-term bisphosphonate use. An expert from Johns Hopkins Hospital, writing in the Journal of the American Medical Association, describes the problem and makes recommendations for dealing with it.

“Evidence to date suggests that atypical fractures in bisphosphonate users are infrequent, and this potential problem should not preclude initiation of therapy in [osteoporotic] patients at risk of skeletal events”, writes Dr Sellmeyer.  Such fractures amount to less than 1% of all hip and femur fractures overall.  The main strategy recommendations are directed at the patient-physician relationship;  the physician must be well-informed of the possible risks and benefits of this type of treatment the  particular patient, and the patients must be aware of the need to work closely with her physician, over the years.  For instance, thigh pain in someone who has been taking Fosamax for several years is a potential alarm signal, suggesting the need for a radiology exam.  Consideration should be given to a 12-month interruption in treatment after 5 years’ continuous bisphosphonate use.  This may depend on the results of bone density measurements.  As you can see, it’s complicated; each patient requires individual, tailored, management of their osteoporosis, in light of these new findings.