Q: This is a question about Reclast, a drug that is supposed to help your bones. I am 75 years old and my doctor says I have osteopenia. I am currently taking Fosamax. Would this new drug help my bones better?
A: Osteopenia is often a precursor to osteoporosis and is a condition in which bone mineral density is lower than normal. A loss of estrogen as an individual ages, a sedentary lifestyle, the excessive consumption of alcohol, the habit of smoking, the extended use of glucocortoid drugs, and more may contribute to the condition. According to the pharmaceutical company that manufactures Fosamax, in 2003 there were about eight million women determined to have a diagnosis of osteopenia and of that amount, approximately one third were taking an osteoporosis drug.
The treatment for osteopenia remains controversial. According to 2008 recommendations from WHO (the World Health Organization), therapy should be considered if the individual has specific readings on a DEXA report, if there is a probability of hip or major osteoporotic fracture in the upcoming 10 year period, or if the prescribing physician and patient together deem it appropriate because of the extended 10 year risk.
Fosamax (alendronate) is in a group of drugs known as bisphosphonates. Its purpose is to slow bone loss and increase bone mass which hopefully prevents bone fractures. It is commonly prescribed for women to prevent osteoporosis caused by menopause, as well as in those individuals who have been diagnosed with Paget’s disease or osteoporosis that results from taking steroids.
Reclast, also a bisphosphonate, is recommended for individuals with Paget’s disease, a diagnosis of osteoporosis determined by a bone mineral density scan, and other conditions. Because Reclast is an IV medication, it may be preferable if you are having gastrointestinal issues with your Fosamax.
On the downside, Fosamax, Reclast and other bisphosphonate therapies have been reported to cause osteonecrosis (bone death) in the jaw, so perhaps a change to another class of drugs may be appropriate in your case.
Did your physician show you the results of your scan? Either way, you need additional information and some questions answered prior to making a determination as to whether you should make the switch from one medication to another. In this and in all instances, every patient should be well informed of the potential risks, long-term effects, positive aspects, and all else he or she may have questions about. Make an appointment with the prescriber of your Fosamax. Determine how severe your diagnosed “osteopenia” is and ask about the potential risks and benefits of a switch. Without knowing your numbers, I cannot inform you what your best choice is. If you feel you may not be able to understand what he or she says, take a family member or friend with you and make it clear the individual is there at your request. Then you can make an educated decision and progress from there.
