Osteoporosis is a disease that causes bones to become brittle and fragile, which makes them more susceptible to breaking. Osteoporosis, which means “porous bone,” is more common in women than in men. The bone fractures and consequent pain and disability can seriously affect women’s health and quality of life. Some women, particularly those without good access to health care, experience fractures that could have been prevented if their osteoporosis had been treated. Yet, many women who are warned about the dangers of osteoporosis don’t actually need to worry.
Drug manufacturers conduct aggressive advertising campaigns targeted at women and health care providers about the dangers of osteoporosis. (Women are also being warned about “osteopenia,” a term that describes reduced bone density, but is not actually a disease or a disorder.)
Women who have been diagnosed with osteoporosis or osteopenia are usually told they need to take prescription medications to prevent further bone loss and reduce the risk of fractures. As a result, many women take these drugs unnecessarily — despite their serious side effects and dangers.
The two most common treatments are hormones and bisphosphonates.
Hormone treatment has been approved by the Food and Drug Administration (FDA) to prevent osteoporosis — but not to treat it. Both estrogen alone and combinations of estrogen and progestin reduce women’s risk of osteoporosis and bone fracture. But, these hormones also increase the risk of breast cancer, heart attack, stroke, and pulmonary embolism. So, taking hormones should be the last choice for osteoporosis prevention. Further, hormones should only be used if other prevention methods are unsafe or inappropriate for a particular woman.
A type of drug called “bisphosphonate” is also widely prescribed to prevent and treat osteoporosis. Some bisphosphonates are taken daily, while others are taken on a weekly, or even an annual, basis. Bisphosphonates decrease bone absorption and slow down bone loss. The drugs are incorporated into newly formed bones and can stay in them for years, so their effects last after a woman stops taking the drugs.
Bisphosphonates seem to have fewer risks than hormones, at least in the first five years of use, but are not risk-free. There have been numerous reports of women who use bisphosphonates having unusual bone fractures that take longer than normal to heal. Some women report experiencing severe bone, joint, and/or muscle pain after starting to use a bisphosphonate. The FDA advises patients with such pain to consider discontinuing the drug, which usually causes the pain to go away. The FDA also notes that long-term use may not be helpful, and advises women with low fracture risks not to take bisphosphonates for more than five years.
There are alternatives to drugs for making and keeping bones strong. The National Institutes of Health’s 2000 Consensus Statement on Osteoporosis reviewed the research on osteoporosis prevention and treatment and found strong evidence that calcium and Vitamin D intake are crucial to develop and preserve strong bones. Regular exercise, improved balance, and making sure your home is free from trip hazards are also good ways to stay healthy and avoid fractures.
Drug companies are clearly trying to expand the market for osteoporosis drugs; their latest efforts target “non-traditional” populations (like younger women and men) for screening. This is not necessary. The National Women’s Health Network (NWHN) has long urged the Food and Drug Administration (FDA) to enforce more stringent standards for osteoporosis drugs.
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Updated August 2015