author and cofounder of the U.S National Women's Health Network

Read the July 6, 2005 JAMA review of The Myth of Osteoporosis

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Not a happy new year so far for Merck pharmaceuticals with a swathe of damning reports on their osteoporosis drug Fosamax appearing on January 1st 2009:

• Dr Diane Wysowski of the FDA reports an increased risk for cancer of the esophagus with Fosamax use in the New England Journal of Medicine;
• The Journal of the American Dental Association publishes a study by Parish Sedghizadeh and his colleagues finding an alarming four percent of their dental patients taking Fosamax have osteonecrosis of the jaw;
• A further NEJM article contradicts everything we have been told about the way bisphosphonates work in the body.  It now seems they increase rather than decrease osteoclast cell production and that these feral bone-absorbing cells are giant and detached. What this means nobody knows. Hardly stuff to inspire confidence in users!

If bisphosphonates offered significant fracture prevention it may be worthwhile debating the benefits and risks. But the majority of the millions who take these drugs do not stand to benefit AT ALL.  Meanwhile these are toxic compounds that stay in the body. Their mechanics of action are still not understood, and users remain guinea pigs in a massive experiment.
A diagnosis of osteoporosis on the basis of a bone density test alone is flawed and close to meaningless. The widespread prescribing of bisphosphonates based on a bone density diagnosis has the ‘worried well’ taking the drug in droves believing they are preventing a disease may never have.
The lengthening litany of side-effects: chronic and acute joint bone and muscle pain, sudden serious fractures of the femur, atrial fibrillation, osteonecrosis of the jaw, inflammatory eye disease, and now cancer of the esophagus should have even the most passive of Fosamax , Boniva, Didronel and Actonel users closely questioning their doctors.

December 2008

Bone Health Breakthrough?
A sensation was created in osteoporosis research circles recently (Nov 26 2008) when a report published in Cell revealed that serotonin made by the gut appears to control bone formation. Osteoporosis authorities expressed surprised at the development which the investigators hail as a breakthrough that could lead to a new and very different treatment. The preliminary research was conducted on mice that were engineered to have human genes.
Ninety-five percent of serotonin in the body is produced in the gut and only 5 percent in the brain. The discovery is linked to a gene called LRP5 which controls an enzyme that converts the amino acid tryptophan to serotonin in the gut. The new research indicates that high levels of gut serotonin inhibit bone growth, and lowered levels of serotonin make bone denser.
The serotonin link to bone strength was identified in children with a rare condition of very weak bones and in people with extremely dense jaw bones. These conditions were found to be due to mutations of the gene LRP5 which in turn either impaired or increased bone formation. The projection from the discovery is that a drug may be created that reduces serotonin production in the gut thereby stimulating bone growth.
As exciting as it sounds, the information may not alter what we know about age-related osteoporosis as the investigators found osteoporosis patients tend to have normal serotonin levels. And in the trial, animals with normal genes that were fed a tryptophan deficient diet didn’t grown denser bones. Time will tell whether this apparent ‘breakthrough’ will translate into a safe and effective new treatment.  Read more…

New Osteoporosis Documentary
The Osteoporosis Story: Broken Bones or Broken System  examines the historical 1992 redefining of osteoporosis, the multi-billion dollar drug and device industry that burgeoned in the wake of the new definition, and the untold numbers of adverse health events that occurred as a consequence.  The documentary covers the essentials on bone metabolism, details the serious limitations and risks of past and current osteoporosis drug therapies, and questions how ‘evidence-based’ medicine can favour profit before patient safety.  It includes women’s stories on the debilitating effects that bisphosphonate drugs like Fosamax have had on their lives; along with Swedish, Canadian, Georgetown, Harvard  and UCLA physicians’ views on the over-selling of the disease, and comments by leading medical authorities and health activists on the woeful state of much of the science behind the osteoporosis ‘epidemic’ and medicine in general. The Osteoporosis Story was written and directed by Ross Johnston and produced by JPL Productions Dunedin New Zealand.  It can be purchased on line at www.theosteoporosisstory.com

More bad news for bisphosphonates
A National Women’s Health Network article  Bone-Breaking Drugs? reports on the sudden increased incidence of unusual and serious fractures of the femur (thigh bone) in women taking Fosamax (alendronate) for more than four years.  A  Medline search revealing more than 50 reported cases suggests an epidemic of such fractures say the authors Adriane Fugh-Berman and Charlea T. Massion, as reported cases usually tend to be the tip of the iceberg.
 Reports of serious adverse reactions to bisphosphonate drugs continue to accumulate, indicating they may be doing far more harm than previously thought.  Jaw necrosis and other bone necrosis (bone death) is associated with bisphosphonate use and many dentists now won't work on orthodontic problems in people on bisphosphonates  as even without osteonecrosis of the jaw,  there is an overall impairment of bone repair mechanisms. Earlier this year the FDA issued an alert regarding chronic and debilitating joint bone and muscle pain. And recently, after examining the evidence the FDA has not been able to confirm that the drugs cause irregular heart rhythms (atrial fibrilliation), but can’t rule it out, either. The FDA says it will do further studies of this issue, but in the meantime it has alerted women about the possible problem. 
A 2006 literature review published in Drug Safety concluded that the underreporting by US physicians of adverse drug reactions including serious and fatal adverse drug reactions is in excess of 90 percent.  Astonishing!  If you or someone in your family has experienced a serious reaction to a bisphosphonate drug or any medical product, you can now report directly to the US Food and Drug Administration MedWatch program by going to the MedWatch homepage clicking on "How to Report", then "Reporting by Health Professionals" or "Reporting by Consumers". Or you can report your adverse experience directly to the MedWatch Program by calling call 1-800-FDA-1088.

There are also consumer websites like  http://www.askapatient.com or http://www.topix.com/forum/drug/ where you can read others experiences, ask questions and discuss your concerns.

Bone health tips:
• Exercise and a nutrient-rich diet are the most effective strategies to avoid osteoporosis. A diet that covers the diverse nutritional needs of bone including calcium, magnesium, vitamin K, boron, manganese, zinc, copper, silicon and others nutrients is ideal. Fresh vegetables, fruits, nuts and seeds are good sources of these foods. Limit heavy protein and salt intake, reduce alcohol, don’t smoke, and for essential vitamin D, get sunlight on your skin at safe times of the day.
• Exercise often! The fastest way to increase bone strength is resistance exercise using small dumbbell weights and other muscle building exercises. Applying strain to bone makes it stronger. Older adults who regularly use weights in this way are generally healthier. Flexibility and balancing exercises like Pilates, Tai Chi and yoga are also important.
Higher impact activities like running, jumping and jogging are very effective, but regular aerobic exercise such as walking is also beneficial. Research has demonstrated that we can benefit from exercise at any age – even centenarians will experience an increase in strength, stamina and muscle mass. Exercise programs have been found to reduce the frequency of falls in high risk older people.
• Educate yourself about bone health. Understand that a diagnosis of low bone density (osteopenia) or osteoporosis is not sufficient reason to embark on a treatment regime. There are many other risk factors for osteoporosis such as previous fragility fracture, smoking, corticosteroid use and so on which need to be considered when a diagnosis is made. If you are worried, make sure you are tested for secondary causes of osteoporosis and other rare conditions that your doctor will know about.

Wishing you a Merry Christmas and safe holiday season,

Gillian

Previous Posts:

• Strontium as an osteoporosis treatment.
• Bisphosphonates - how safe and effective are they?
• bisphosphonates and osteonecrosis of the jaw (external link)
• Evista – what is it good for again?
• The effects of StatinsThe effects of Statins
  Although cholesterol lowering drugs have been on the market for more than 20 years there is still much that is not known about their effects. Patients taking statins (such as Lipitor, Zocor, Pravacol, Mevacor and Crestor) may experience side-effects such as joint pain or memory loss and not realize they may be linked to the statin. Beatrice Golomb who heads the USCSD study into statins has recently launched a website at www.statineffects.com so that users can report adverse or positive effects. The evidence collected will provide a more accurate picture of the effects of these drugs – something that the FDA’s lack of post-marketing surveillance has not provided. The site also provides helpful information including lists of well known and lesser-known side-effects.

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By Gina Kolata
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For a nation that spends more than any other on health, the United States certainly doesn't seem very healthy. Many cancers are on the rise — prostate, breast, skin, thyroid. We're fatter than ever. As for diabetes, the number of people who say they have it has doubled in the last 10 years. Now a report says that the English — those smoking candy-eating, fish-and-chips lovers — are actually healthier than Americans. And they spend half as much on health care. More... (you will need to do the free subscription thing if you haven't already)

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Barbara Seaman, author of The Greatest Experiment Ever Performed on Women, and the most influential and courageous advocate for women, has graciously given our website her latest excellent article - a fascinating account of the history of infertility treatments, the sociological implications of infertility, and the misinformation around this most controversial and emotive issue.

IT IS COMMON ENOUGH. You may have a friend or relative or neighbor who underwent fertility treatments. You yourself may have experienced the painful and costly rounds of pills, injections, egg harvesting, and implantation. There's a lot at stake when you sit down to research the safety and efficacy of different kinds of reproductive medicine. You must be prepared to ask tough questions. You must be skeptical of the claims made in mainstream websites and books, for some are nothing more than marketing tools. What follows is an overview of the history of treating infertility in this country, some feminist ideas about it, and some recent thinking. More...

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