There's bad news along with more bad news today for women worried about bone loss. A study published in the Archives of Internal Medicine finds that taking alendronate (Fosamax)—one of the most popular drugs to treat osteoporosis—nearly doubles a woman's risk of developing a dangerous irregular heartbeat. About 7 percent of those who used the drug developed atrial fibrillation, which can cause potentially deadly strokes, compared with 4 percent of those who never took it. The finding suddenly makes it look more perilous to counter bone loss. And since many conditions and medications can cause bone loss, plenty of women are left in a dilemma.
A second study in the same journal found that those who took the diabetes drugs rosiglitazone (Avandia) or pioglitazone (Actos) had double or even triple the odds of experiencing a hip, wrist, or other nonspinal fracture compared with those who didn't take either drug.
Let's put these two studies together, shall we? Diabetics who take either Actos or Avandia can't simply take Fosamax to counter the bone-loss side effect. In fact, diabetics who took the bone-building drug in the first study had an even greater risk of atrial fibrillation than nondiabetic users. So, too, those women who were taking both Fosamax and a cholesterol-lowering statin. (This is presumably because diabetics and statin users are already predisposed to heart problems.)
Many women may have already been warned off Avandia after recent studies linked the drug to an increased risk of heart attack. Actos, meanwhile, has been associated with heart failure. But there are plenty of other drugs that are now thought to cause bone loss: In fact, a study published today by Neurology found that women who take the anti-epilepsy drug Dilantin had an accelerated rate of bone loss. Other research has found similar effects in antidepressants and aromatase inhibitors for preventing breast cancer recurrence, which I blogged about last month. Medical conditions like diabetes and depression are also known to increase the risk of osteoporosis, even in younger women. Experts I have interviewed previously about aromatase inhibitors have been quick to recommend that doctors prescribe Fosamax along with the breast cancer drug. But they may not have been taking into account Fosamax's potential side effects.
In light of today's findings, it may be time to rethink the "just give a bone-building drug" solution to any medication or medical problem that leaves bones brittle. An editorial that accompanied today's two Archives articles emphasizes that doctors need to weigh the "risks associated with no treatment" against the "benefits, risks, and adverse effects of each therapy." For women with osteoporosis, the authors conclude, current evidence indicates the benefits of Fosamax outweigh the risks of atrial fibrillation. The evidence isn't quite as clear for women with moderate bone loss, however, but here's a road map for helping them grapple with the condition called osteopenia. Perhaps their best bet is to make a concerted effort to reduce bone loss through lifestyle approaches. Here's the best exercise program for building bone and how to get more bone-building nutrients like vitamin D and calcium.