A series of noteworthy studies poses strong doubts on long term use of alendronate (Fosamax in Italy) and compels doctors to seriously re-examine the pharmaceutical therapy used for osteoporosis.

Italian version

A series of noteworthy studies poses strong doubts on long term use of alendronate (Fosamax in Italy) and compels doctors to seriously re-examine the pharmaceutical therapy used for osteoporosis.

As our readers know, Eurosalus is critical of the conflicting use that is made of the MOC. The fact that only the T score is used for evaluating a subject and the Z score is not considered makes this test questionable.

Practically speaking, the first reference value refers to a young, healthy, male adult (for example. a twenty-year old "Top Gun"). With this type of reference model any man or woman, even if perfectly healthy, would have a lower reference value. Anyone who bases his assessment on these parameters "condemns" perfectly healthy people to a diagnosis of osteoporosis!

Doubts on this subject were recently expressed in an excellent review that appeared in NEJM (Raisz LG. N Engl J Med Jul 2005;353:164-71).

Thanks to an American study (Odvina CV, et al. J Clin Endocrinol Metab. 2005 Mar;90(3):1294-301. Epub 2004 Dec 14) that can be seen on Medline and another more recent work (Richer E et al, Osteoporos Int. 2005 Feb 22; [Epub ahead of print]) that also appears on Medline , it seems that long term use of alendronate could actually cause the opposite effect, that is, the weakening of the bones and therefore increases the risk of fracture.

Prolonged use of these substances leads to the loss of bone elasticity and thus exposes a bone that is perhaps more compact to a greater risk of fracture. Richer's study compares the risk of elasticity loss with that which can occur in dialysis or with cortisone treatment.

As we've stated many times, even though a pharmaceutical drug may be useful during a transitory moment of one's life, therapy for osteoporosis must pass through important behavioral changes: diet and physical activity must be modified in accordance with the body's general well-being.

Sometimes it's necessary to evaluate the body's state of mineral balance and often a supplement of Boron (at least 3 mg per day) is useful. On the other hand, the devastating effect of excess salt must be counteracted and one's calcium requirements must be supported each day by all of the foods that contain it without limiting oneself to just a morning yogurt!

p> It's also interesting to observe how some studies that advise the use of milk for keeping osteoporosis under control even during menopause insist that the milk be enriched with vitamin D and Calcium (Palacios S et al, Menopause. 2005 Jan-Feb;12(1):63-8). In this way, they add a variety of other elements to supplement a food that is important, but not exclusively so,  for helping anyone  re-fortify his or her bones.

Italian version