Five years of osteoporosis treatment can yield 10 years of protection

Patients who take alendronate (Fosamax) for five years have nearly the same protection from bone fractures as patients who take the bone-building drug for 10 years, according to new research.

A national study of 1,099 women with osteoporosis suggests that alendronate -- one of a class of drugs called bisphosphonates -- builds up and persists in the body’s bone until it is released and reactivated by osteoclasts, or bone-remodeling cells.

Duke geriatrician Cathleen Colón-Emeric, MD, MHSc, wrote the editorial that accompanied the study in the December 27, 2006, issue of the Journal of the American Medical Association. She says patients who have done well on alendronate can safely consider a “holiday” from the drug. This option would apply only to those who have not suffered a fracture or a significant loss of bone density.

Patients could save not only five years of prescription costs, but also any side effects of the drug, which for some include reflux disease.

We asked Colón-Emeric what readers should take away from this new revelation about a popular drug.

Should osteoporosis patients who are not on alendronate consider switching to this drug?

The study was a comparison of alendronate versus a placebo. So it doesn’t make any comparisons in the effectiveness between alendronate and other medications.

Should all patients who are now taking alendronate -- who don’t develop fractures or drops in bone density -- expect to be able to quit after five years?

Patients who have a high risk of spine fractures, which is usually due to extremely low bone density, would want to consider their risks carefully before they stopped taking the medication. But for most people it would probably be a reasonable choice.

If a patient had opted not to take alendronate or another type of bisphosphonate, should she reconsider?

It depends on why she chose not to take alendronate. Some people have a risk of developing serious side effects such as uveitis, esophageal ruptures, or osteonecrosis of the jaw when taking this class of medications. For those individuals, it would probably not be worth the risk.

However, lots of folks choose not to take this drug because of concern over acid reflux. If that is the case, they may find it worth reconsidering. It’s an attractive benefit of this drug, to be able to get 10 years of benefit for only five years of taking it.

After five years off of alendronate, is it likely that most patients would need to go back on medication?

That’s a good question, and there will probably be lots of future discussion about this scenario because we don’t currently know the effect of restarting alendronate or another medication. Certainly, we would more carefully monitor patients after they have been off alendronate for five years. That means that, say, every two years the patient would need to have her bone density carefully examined.

If there were a drop in bone density, the patient would need to consider going back on the drug, or another class of medications.