Dear Dr. Roach: I am an overweight, 65-year-old Caucasian woman who recently had a DEXA scan and, based on the results, my family doctor prescribed Fosamax to treat osteopenia.
With the first dose, I had a severe reaction two days after taking it, with excruciating pain in both arms, neck and legs. I was in terrible pain for two days, then it subsided. With the next dose a week later, I hesitated, but decided to take it anyway. Two days later, the reaction came back, even worse. I could barely walk and had very little energy. I spent four days in bed, except to go to the bathroom. I didn’t take my prescription for Lasix during those four days because I could barely make it to the bathroom.
I contacted my doctor and he has taken me off Fosamax. He has referred me to a rheumatologist. I read that this drug lists all my symptoms and more under the warning for severe reactions. I will not be taking it anymore. I also heard from a friend that this drug has no effect on osteoporosis after 20+ years of drug testing and that I should never have been prescribed this drug since I have osteopenia, not osteoporosis. What do you think? — CW
Answer: Alendronate (Fosamax) is in a class of drugs called bisphosphonates. These are powerful drugs and should not be prescribed lightly. They can cause serious side effects. Severe musculoskeletal pain can occur days or months (even years) after starting the drug. The U.S. Food and Drug Administration advises prescribers to discuss this possibility with patients and to discontinue the drug immediately if such symptoms occur. If patients truly need treatment, there are other options.
Your friend is half right. Powerful drugs like Fosamax are not usually indicated for people who have low bone mass (osteopenia) without osteoporosis. But if you have a history of fragility fractures (fractures caused by minor trauma that are not thought to have caused the fracture), you may be diagnosed with osteoporosis even if your bone mineral density is not in the normal osteoporosis range. You may also be at high fracture risk for other reasons, and a clinical tool called the FRAX score can help clinicians identify those who are likely to benefit from treatment.
But your friend is half wrong. Used appropriately, Fosamax and other bisphosphonates are effective at reducing the risk of fractures. While vertebral fractures can cause pain for years and are easily avoidable, hip fractures can be devastating. So there is good reason to prescribe these drugs.
Finally, we would like to warn readers not to become complacent with treatment with these drugs. Although these drugs may be appropriately prescribed for high-risk individuals, most people should not continue taking them forever. Follow-up DEXA scans will guide treatment, and a conscious decision should be made after 3-5 years whether to continue treatment.
Readers who have been taking these medications for more than five years and have not been closely followed up on their results should ask their doctor whether they still need to take them.
Dr. Roche regrets that he cannot respond to each letter individually, but will incorporate as many as possible in his column. Readers can send their questions to [email protected] Or mail it to 628 Virginia Dr., Orlando, FL 32803.
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