Monday, March 4, 2024

How long do you need to take a bone-building medicine?

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 Q: My doctor wants me to start taking a particular medication once a week to strengthen my bones. How long do I have to take it?

Our bones can lose strength as we age, making them thinner and more likely to break.

How long do you need to take a bone-building medicine? That depends on how thin your bones are and if you have a history of a fracture due to thin bones.

May is National Osteoporosis Awareness and Prevention Month. Osteoporosis is a disease that causes your bones to become thinner. When you have osteoporosis, a simple fall can shatter a bone, causing months of painful rehabilitation and, for some, permanent disability and loss of independence.

Sometimes, bones are so weak that they break spontaneously. A hip fracture can cause a fall instead of being the result of one. The vertebrae of your spine can become so frail that they collapse. This can pinch nerves and twist muscles out of position, causing deformity and pain.

When heavy equipment resurfaces a highway lane, it removes the top layer of the road surface, mixes it with hot tar, then pours it back onto the road surface.

Our bones follow a similar pattern, continuously recycling the calcium, phosphorus, and other minerals they contain. Like the machines that chew up the top layer of roadway, then lay it down as a new surface, we continuously take up bone cells, then lay them back down.

Until age 35, this process increases our bone density. As our body recycles bone cells, it puts back a few more bone cells than it takes out, which makes our bones stronger. But around age 35, that balance starts to shift. Eventually, our bone cell recycling process no longer returns all the cells it takes out. Over time, our bones become thinner.

Luckily, there is a way to discover the density and “strength” of your bones, the DXA scan, also called a DEXA scan. DXA scans measure bone thickness in several critical areas to determine bone mineral density.

During this painless procedure, two low-dose X-rays are sent into the pelvis, hip, and lower spine bones. The results are used to calculate the bone mineral density of each area. The lower the density of those bones, the greater your fracture risk.

If your bone density is low, further bone loss can be slowed with treatment. You may be at an increased risk of thin bones if you are post-menopausal or have taken certain drugs frequently, especially prednisone.

Certain conditions accelerate the process of losing bone cells. Taking prednisone for months to years decreases bone density, and smoking cigarettes can accelerate bone loss. Menopause also triggers a doubling of the rate of bone loss. 

About half of repeat fractures from osteoporosis can be prevented with appropriate treatment.

Bone-building drugs like alendronate (Fosamax®), risedronate (Actonel®), and Boniva®, called bisphosphonates, are the first choice for boosting thin bones. These powerful medicines have complicated directions and are easier to take in the once-a-week or once of monthly formulations. They must be taken with a full glass of water on a completely empty stomach, and you must sit upright for at least 30 minutes afterward.  

Keeping yourself upright and drinking a full glass of water helps avoid irritating your esophagus. An empty stomach is essential because only 2-3% of the medicine in each tablet will be absorbed into your body.

What does get into your bones stays there. These drugs become part of your bone cells and help build bone for you even years after you stop these medications.

Another form of bisphosphonate is a yearly infusion. This is particularly helpful if you cannot take the pills because of problems with your stomach or esophagus.

So how long do you have to take Fosamax® or Actonel®? That depends; you and your doctor should decide together.

Five years of treatment should be enough if you have not yet had a fracture, and take them only as prevention. Both alendronate (Fosamax®) and risedronate (Actonel®) help to prevent hip and vertebral fractures for up to ten years, even after you stop taking them.

Beyond five years, there is more risk of having a dental emergency called osteonecrosis of the jaw.

Bone-building medications include bisphosphonates you take once weekly, once monthly, or once yearly. Another type of bone building medication available requires twice yearly injections.

Getting adequate calcium and vitamin D, plus weight-bearing exercises also helps strengthen your bones. Check with your doctor about your risk of osteoporosis and your options for treatment. 

Dr. Louise Achey, Doctor of Pharmacy, is a 43-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog, TheMedicationInsider.com.

Ó2023 Louise Achey

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