- Home>
- Primary Care>
- General Medicine>
- Summary and Comment
Is Long-Term Bisphosphonate Therapy Safe?
In a case series, long-term alendronate use was associated with reduced rates of bone formation and inadequate fracture healing.
Bisphosphonates (alendronate [Fosamax] and others) inhibit bone resorption and reduce the incidence of fractures in osteoporotic patients during several years of use. However, these drugs theoretically might weaken bone in the longer term (e.g., by inhibiting normal repair of bone "microdamage" that occurs in daily life).
These researchers evaluated nine patients who sustained nontraumatic nonspinal fractures (e.g., of the femur or pelvis) after 3 to 8 years of alendronate therapy. Three patients also used estrogen, and two took glucocorticoids. Bone biopsies with labeling studies revealed severe reductions in bone formation rates in all patients compared with previously published rates in healthy postmenopausal women. Eight to 12 months after discontinuation of alendronate, fracture healing was inadequate in four patients.
Comment: This provocative report suggests that, in some patients, long-term bisphosphonate therapy may be associated with weakened bone and increased susceptibility to fractures. Obviously, this uncontrolled case series cannot establish cause and effect, but it does signal a need for closer attention to this potential problem. According to a recent study, the safety and effectiveness of alendronate persisted during 10 years of use, but that study was not designed to detect increased susceptibility to fractures in subgroups of long-term alendronate users (Journal Watch Apr 2 2004). An editorialist suggests that bisphosphonate therapy in osteoporotic patients should be stopped after 5 years, pending additional research to clarify the risks and benefits of long-term therapy.
— Allan S. Brett, MD
Published in Journal Watch General Medicine April 5, 2005
Citation(s):
Odvina CV et al. Severely suppressed bone turnover: A potential complication of alendronate therapy. J Clin Endocrinol Metab 2005 Mar; 90:1294-301.
- Original article (Subscription may be required)
- Medline abstract (Free)
Ott SM. Editorial: Long-term safety of bisphosphonates. J Clin Endocrinol Metab 2005 Mar; 90:1897-9.
- Original article (Subscription may be required)
- Medline abstract (Free)