Q: I am a healthy 65-year-old woman with osteoporosis. I have been treated with Boniva, as well as Fosamax. I experienced jaw pain while taking both medicines. My latest DEXA scan showed more deterioration in my spine and both hips. My doctor has now recommended Reclast. I have spoken to other medical personnel who have said not to do the treatment. After reading the side effects of the treatment, I am seeking a second doctor’s opinion. I have not read any articles in your column regarding this subject. What factors should be considered before taking the treatment and what would you recommend? Thank you.
A: Let’s first touch on the two treatments you chose to discontinue. Boniva is in a class of drugs known as bisphosphonates (drugs designed to prevent the loss of bone mass in individuals with osteoporosis) in post-menopausal women. The medication is believed to increase bone mineral density, while reducing the incidence of fractures of the vertebrae. The optimal duration of use for this product has not yet been determined, yet it is believed individuals at a low risk for fractures should discontinue Boniva following three to five years of use. Side effects include osteonecrosis (bone death) of the jaw from the use of Boniva, as well as from other drugs in the same class.
Fosamax (alendronate) is yet another bisphosphonate prescribed to slow bone loss in post-menopausal women with osteoporosis. And again, osteonecrosis of the jaw, blood clotting disorders, anemia, and more are included in the list of possible side effects from this drug.
Reclast was designed to reduce the incidence of hip, vertebral and non-vertebral osteoporosis-related fractures in post-menopausal women and men with osteoporosis. It is also prescribed for individuals with Paget’s disease of the bone. Paget’s is a chronic disorder that may result in enlarged and misshapen bones caused by the excessive breakdown, formation and re-formation of bone. The drug is administered once a year intravenously. Those situations for which the drug is contraindicated include patients diagnosed with hypocalcemia, malabsorption syndromes, hypoparathyroidism, bone/joint/muscle pain, unusual thigh bone fractures, a creatinine clearance of less than 35 mL/min, and in those with acute renal impairment because of an increased risk of renal failure. Again, the same unwanted side effects of other bisphosphonates are a possibility, as is severe bone/joint/muscle pain.
I’m slight confused as to why your prescribing physician has chosen to prescribe three products in the same drug class that all have relatively similar potential side effects. The next level of care beyond bisphosphonates are a class of medications known as selective estrogen receptor modulators such as Evista (reloxophene) that has an 8-year safety record and has demonstrated breast cancer prevention properties. There are also other drugs that you might consider asking an endocrinologist about, such as parathyroid hormone, Denosunab, and others.
You might consider speaking with your physician regarding a trial basis of such things as name brand calcium supplements, adding weight-bearing exercises on a daily basis that may include walking, jogging, aerobics, or resistance exercises. Consider tai chi and participate in classes to improve balance in an attempt to prevent fractures. Limit any alcohol consumption to no more than two drinks per day, since heavy alcohol use may decrease bone formation. Discontinue smoking if appropriate. Add a calcium supplement,TUMS, plain yogurt, milk and products fortified with calcium. Generally speaking, calcium supplements are safe and in most instances, are well-tolerated; however, side effects may include constipation and indigestion. If your physician is in agreement, my recommendation is to set a time limit for the testing and be sure to have another DEXA performed to determine if your efforts can be effectively handled without taking a prescription drug. Good luck.
