While I hope that things will change as time and research moves on, I do not remember a time that a patient has come into my office that had been placed on some type of anti-resorptive therapy (Fosamax, Boniva, Actonel, Zometa) for osteoporosis that were recommended to take anything other than calcium. As current research is demonstrating, this recommendation falls far short of providing a benefit.
Remember that these drugs do NOT add bone. Most everyone seems to be under this impression, but it is not true. They merely slow down our body’s breakdown of bone by irreversibly binding the osteoclast cells that break down bone. The standard recommendation has been to take calcium, but this again is falling short in the recent research. And keep in mind that a large chunk of people taking this class of drugs do not respond at all (this article notes the number is about 30%).
Vitamin D, however, stands strong in bone health. This particular study looks at patients’ response to drug therapy and finds that, in those with low levels of Vitamin D, they did not respond to the drug. Imagine the decades that these drugs have been used and the ramifications of this study. Not only are we treating bone density issues inappropriately (more on this in a minute), but it means we have been falling short on what benefit there may be by taking years for clinical recommendations from the research to be put into play.
A few side notes. First, osteopenia vs osteoporosis. WE DO NOT USE DRUGS TO TREAT OSTEOPENIA!!!!!!!!!!!! Ugh!! Can’t tell you how often I have to address this issue. There are no clinical trials or drug approvals that I’m aware of (could just be out of date) that use drug therapy to treat osteopenia. Why? Because the actual risk of fracture is someone with osteopenia is very low. Rather, it is an indication that the trajectory of bone health is in the wrong direction. This is a lifestyle issue that needs to be fixed.
So, if the risk at that point in life is very low, that means that, to lower the risk of fracture in the future when the risk becomes more imminent, the patient will need to be on these drugs for a long time. However, the research suggests that 3-5 years is about how long someone should be on these drugs because it increases the risk of atypical fractures. Thus, you do NOT medicate osteopenia!
On to the real problem. Bone health is a lifestyle issue. It has to do with activity levels. Vitamin D levels. It has to deal with inflammation (increased inflammation makes more of the osteoclasts that break down bone so, more inflammation = more bone breakdown). It has to deal with poor digestion / gut stress. And yes–I said the gut. Growing evidence is suggesting that the gut and serotonin derived from the gut when it is inflamed is a major player in bone loss.
So you can see why the recommendations to just add calcium or to take Fosamax is very short sighted and in no way addresses the real concerns that have to deal with bone health.