Bisphosphonates are a class of drugs commonly used to treat osteoporosis, and include alendronate, etidronate, risedronate, and zoledronic acid. Bisphosphonates are designed to slow or stop the bone loss that occurs during the body’s natural process that involves removal and replacement of bone tissue. In March 2010, at the annual meeting of the American Academy of Orthopaedic Surgeons, reports suggested that if bisphosphonates are used for four or more years, they may actually impair bone quality and increase the risk of certain bone fractures. Two separate studies by researchers from the Hospital for Special Surgery (HSS) and Columbia University Medical Center revealed data suggesting that long-term suppression of bone remodeling with bisphosphonates may alter the material properties of bone, potentially resulting in brittle bone and contributing to the risk of atypical fractures.

   Bisphosphonates have also been associated with osteonecrosis of the jaw (ONJ), an uncommon but potentially serious condition that can cause severe destruction of the jaw. Initially, it was thought that the greatest risk was in patients with cancer who received treatment with intravenous bisphosphonates. However, a recent study at the University of Southern California found that ONJ caused by oral aledronate was more common than previously suggested. The jaw problem was found in 9 of 208 patients receiving oral alendronate, or approximately 4% of the population. The findings from this study indicated that even short-term oral use of alendronate led to ONJ in a subset of patients after certain dental procedures were performed.          

Concerns about bisphosphonates have prompted many people to search for other forms of therapy to improve bone density and prevent osteoporosis.   

   Declining estrogen levels after menopause result in bone loss and increased fracture risk. Estrogen levels can be increased with transdermal estradiol, which is well tolerated and similarly effective to raloxifene (a drug approved for the prevention and treatment of postmenopausal osteoporosis) in preventing bone loss.   

    In addition, we recommend that both men and women utilize a broad-spectrum bone support program beyond the basic calcium/magnesium/vitamin D in order to optimize bone density and quality and to reduce the risk of osteoporosis.  

http://www3.aaos.org/education/anmeet/anmt2010/podium/podium.cfm?Pevent=339

Accessed March 22, 2010

J Am Dent Assoc. 2009 Jan; 140(1):61-6.

Menopause. 2009 May-Jun; 16(3):559-65.