Potential side effects of bisphosphonates

Are you taking any bisphosphonate medications (such as Fosamax, Boniva, Reclast, Aredia or Actonel) for Osteoporosis or Paget's disease? Such bone diseases have a propensity towards causing a loss in bone mass. Fosamax (and other similar drugs) help in maintaining / increasing the bone density levels of people suffering from certain bone diseases. Physicians now suspect a link between the use of bisphosphonates and a rare condition known as osteonecrosis, where the bone becomes infected and dies. The onset ofosteonecrosis of the jaw (ONJ) is linked with the temporary or permanent loss of blood to bone tissue, leading to death of the tissue and the eventual collapse of the bone. There are approximately 10,000 to 20,000 new cases of osteonecrosis diagnosed each year in the United States, most of which occur as a result of some type of bone injury such as a fracture or dislocation. The link to oral osteonecrosis was noted when patients who were on certain forms of bisphosphinates had teeth removed and developed osteonecrosis in the extraction site. Initially research pointed towards patients with cancer as being chiefly at risk because they were given high doses of IV bisphosphonates, but now dentists and doctors are seeing cases in otherwise perfectly healthy patients who are being treated for bone loss.
The American Dental Association recommends that before starting bisphosphonates, patients have a comprehensive dental exam and treat any tooth or gum problems immediately to attempt to prevent the need for invasive procedures later. In addition, while on bisphosphonates, you must ensure your home care is impeccable: brush regularly, floss daily, and keep your dental recall appointments. If invasive dental care is necessary after you have begun bisphosphonate therapy, you should discuss the implications with us so we can determine the best course of treatment. Please be sure to let us know if you are now taking, or if you are considering taking bisphosphonates.
Additionally, recent news reports have raised concerns about the potential for bisphosphonates to cause spontaneous femur fractures in patients who take the medication for five years or more. In early March 2010, ABC News aired an investigative report citing many instances of patients (mostly women) on bisphosphonates experiencing sudden fractures of the femur just below the hip joint -- injuries that are clinically known as "atypical subtrochanteric femur fractures." These fractures are especially alarming because they happen while the patient is engaged in relatively low-stress activities. Dr. Kenneth Egol, a professor of orthopedic surgery at Langone Medical Center, said that fractures are occurring in patients who are "just walking, walking down the steps, patients who are doing low-energy exercise." Dr. Egol characterized such fractures as "very unusual" because "the femur is one of the strongest bones in the body.Two studies presented at the March 10, 2010, annual meeting of the American Academy of Orthopaedic Surgeons add clinical weight to doctors' anecdotal reports of Fosamax-related femur fractures. In one study, researchers at Columbia University examined bone scans of 111 women, 61 of whom had been taking bisphosphonates for at least four years. They found that while bisphosphonates initially improved bone strength, these improvements were reversed after four years. In another study, researchers at the Hospital for Special Surgery in New York examined bone samples from 21 women who experienced femur fractures. They found that the women who had received long-term treatment with bisphosphonates had a lower degree of bone-tissue heterogeneity (and thus weaker bones) than those who had received no bisphosphonates.
The FDA is reviewing the research linking bisphosphonates and femur fractures. On March 10, 2010, the agency stated, "At this point, the data the FDA has reviewed have not shown a clear connection between bisphosphonate use and a risk of atypical subtrochanteric femur fractures." However, the FDA said that the agency would continue to gather information on the issue. In the meantime, it advised physicians to continue prescribing the drug and warned patients not to discontinue the medication without first consulting with their physician.