I first heard the word “osteopenia” following a bone density scan reporting a hip bone mass of 0.823 g/sq.cm. I was 57 years old, and my doctor immediately prescribed a medication used to treat osteoporosis. My race, body build, and family history were also working against me. So it seemed reasonable to try to prevent my declining bone mass from becoming worse. Except, as I came to learn, the supporting science really isn’t there.
As a trained scientist myself, I wanted to know more about the Fosamax my doctor had prescribed, and so began the journey to learn what I could about effectiveness and possible side effects. Fosamax is one of the most commonly prescribed bisphosphonate drugs on the market. Bisphosphonate treatments have been shown to reduce the frequencies of bone fractures in patients diagnosed with osteoporosis. They also have the potential to cause rare but serious side effects — such as deterioration of the jaw bone or spontaneous fractures of the thigh bone.
Fosamax has a more common side effect of causing heartburn and stomach pain. Instructions for taking the Fosamax pills are very restrictive, in order to minimize these risks. As I was already having some digestive problems at the time, I delayed starting the regimen in fear of making things worse. While waiting, I stumbled over a set of investigations published by NPR, which completely changed my understanding of my condition.
“Rare Fractures Linked to Drugs for Weak Bones,” discusses recent research findings that women taking bisphosphonates for more than five years have tripled risk for spontaneous fractures compared to women with minimal exposure to these drugs.
A second article, “How a Bone Disease Grew to Fit the Prescription,” investigates how the term “osteopenia” was invented to describe normal demineralization of aging bone as a disease needing treatment. In fact, no long-term studies have tracked the effectiveness of initiating osteoporosis treatments for women in their 50s diagnosed with osteopenia. Experts are starting to recommend that a patient not start taking a bisphosphonate drug unless their 10-year risk of hip fracture is at least 3 percent, and the risk of any fracture is at least 20 percent.
A new tool for calculating risk for osteoporosis-related bone fracture over 10 years has been developed by the World Health Organization Collaborating Centre for Metabolic Bone Diseases (U. Sheffield, U.K.). The FRAX tool is freely available online. If you’ve had a scan for bone mineral density (BMD), you can use the FRAX risk calculator yourself by plugging in your own results and medical history.
My own FRAX calculations showed I have a 10-year risk for hip fracture of 0.4 percent, and a risk for any fracture of 6.4 percent. These values are nowhere near the new treatment recommendations. On this basis, and given the absence of hard evidence that treatment of my osteopenia would prevent eventual osteoporosis, as well as the evidence that treatment could be harmful, I have decided not to start on Fosamax at this time.
What I will do is continue to make sure I get the recommended intakes of calcium and Vitamin D, and I continue weight-bearing exercise. I will also get my bone mineral density measured periodically as recommended, and use the FRAX tool to monitor my results. Most of all, I will continue to keep an eye on the latest research and recommendations, and change my decisions about treatment accordingly.