Osteoporosis Meds

Osteoporosis is a mammoth problem in this country.

Ok, so there’s well-known secret that’s advertised on nearly every osteoporosis drug commercial that treats using bisphosphonates. You don’t pay attention to it until you need the service. What’s the warning? “Osteonecrosis of the jaw (ONJ), which can occur spontaneously, is generally associated with tooth extraction and/or local infection with delayed healing, and has been reported in patients taking bisphosphonates…Known risk factors for osteonecrosis of the jaw include invasive dental procedures…”

So here’s what I’ve seen in ONJ. Patients’ bone doesn’t heal properly. They are chronically sore. Little pieces of bone flake way continually for months or even years. And even when we remove the flaking bone, it still doesn’t heal well. The quality of the bone has changed. It just doesn’t act the way normal bone acts.

In an attempt to reduce the risk of oral surgery in the presence of bisphophonates, we often ask our patients to take a “drug holiday” of three months before we attempt oral surgical procedures on those patients who have been taking bisphosphonates for over three years and then delay resumption of the drug until all areas are thoroughly healed. But even when we do that, there are some patients who still have a delayed healing response.

Bisphosphonates are the most common drug used for treating osteoporosis. I won’t mention the brands here, but if you’re being treated, look at the package insert to see if that’s what you’re taking.

How do bisphosphonates work? There are two primary cells in bone metabolism. The osteoblast forms new bone. The osteoclast that takes the old bone away. A bisphosphonate stops the osteoclast from working. So that means that old bone remains and new bone is laid down on top of and around the old bone. That’s why a bone scan “looks better” after taking a bisphosphonate.

So, not only is osteoporosis a problem, but the treatment is a problem as well. And the problem is not limited only to bisphosphonate drugs. Estrogen-containing drugs have their risks as well.

Calcium has an affinity for estrogen, so the more estrogen, the more calcium. That’s good from a bone standpoint and estrogen-containing drugs do not have the same oral surgery risk that bisphosphonate drugs do. But that doesn’t mean that they don’t have a risk. Increased estrogen is associated with an increased risk of breast cancer.

So what does one do? If you’re new to my columns, my overall theme is “Do everything that you can without medication.” Because if you correct what you might be doing that’s bad for your body, the problem may resolve itself.

So, what should you do? Acid levels in the body seem to make a difference in osteoporosis and alkalizing (non-acidic) foods can make a big difference. Practically all vegetables are alkalizing as well as eggs, plain yogurt, and beans. All meat is acid-forming. A little reading will give you some dietary guidance on acid-forming and alkaline-forming foods. And there’s reasonable evidence that adding some sodium or potassium bicarbonate may help restore bone as well.

In addition, natural progesterone cream, has very beneficial effects with no reported cancer risk. A study by Dr. John Lee found that adding natural progesterone cream to an already established osteoporosis program increased bone density up to 10 percent in 6 months and 3-5 percent annually until stabilizing at the level of a 35 year old. The rest of the program included a diet rich in green vegetables, limiting meat to three times a week, and elimination of sodas, alcohol, and smoking. Along with that was 20 minutes of daily exercise, and Calcium, Vitamin D, Vitamin C, and Beta-carotene. –Alternatives, Dr. David Williams.

Yes, the drugs are there. But wouldn’t it be great if we correct the cause of the problem in the first place?



Note: Dr. Sheldon provides this for informational purposes only. Any treatment decisions should be made in consultation with your doctor.