In last week’s article we learned about the most important causes of poor bone health. We learned that lack of exercise leads to decreased bone mass because the bones need physical activity and load in order to grow and become thicker and stronger. We learned that high phosphate consumption stimulates a hormonal reaction in the body that leaches calcium from the bones. Finally, we learned that nutrient deficiency from poor nutrition, inadequate digestion, or other factors leads to poor bone health due to a lack of raw materials to build healthy bone. In this week’s article we will look at the use of bisphophonate medication, the most common medication used to treat osteoporosis and osteopenia.
Bisphosphonate Medication
Bisphosphonate medication is the most commonly prescribed medication to treat bone health. There are a number of different pharmaceutical companies producing these types of medications. They are primarily used to prevent the breakdown of bone. Thus, they keep bones at roughly the same thickness. Unfortunately, bisphosphonate medications not only prevent the breakdown of bone but they also inhibit the remodeling of bone. This can lead to a weaker bone in the long run.
Recently, a systematic review of bisphosphonate medications was published in the journal, ‘Therapeutics Initiative’ by the University of British Columbia. The results of the study showed, “the small benefits of bisphophonates likely outweigh the harms during the first 3 years of therapy, but harms likely outweigh the benefits for durations greater than 3 years”. The potential harms they are referring to include possible increased risk of atypical femoral fracture, osteonecrosis of the jaw, esophageal injury, and esophageal cancer.
The increased risk for the above concerns is relatively small but appears to be statistically significant for individuals taking bisphosphonate medication for greater than 3 years. The risk increases after 3 years of medication use because the bone is not able to regenerate properly. This may make the bone look thick on x-ray but it lacks the integrity of healthy bone.
Clinical Implications
As a naturopathic physician my primary goal for bone health is to promote healthy bone remodeling. Medications or other therapies that inhibit this process inevitably will lead to less healthy bone in the long run. The most fundamental therapies for bone health (weight bearing exercise, low phosphate diet, preventing nutrient deficiency) were discussed in last week’s article. These will almost certainly always be the most important things you can do to promote bone health and prevent bone thinning.
In most cases, I do not recommend bisphosphonate medication for patients with bone thinning or osteoporosis because there are more effective ways to naturally improve bone health and decrease long-term risks of bone disease. However, there are some people who may be best served by using bisphosphonate medication. I encourage everyone taking bisphosphonates to speak with their naturopathic physician or medical doctor to evaluate their medication.
In next week’s column we will discuss the most important natural supplements to improve bone health and prevent osteoporosis and fractures.
