Too Good to be True: Fosamax

Susanna Euston

The memories haunt me. We’ve just arrived home as the phone rings. “Life Alert” appears on the caller ID. Adrenalin rushes through my body—a familiar response from the involuntary fear I feel each time one of these calls arrives. The friendly but concerned voice on the other end says that my mother signaled for help but did not answer the callback.

Throwing on my coat, I speed out the door, telling my husband that I should be back soon. At least, I hope I will. “Please, let it be another false alarm,” runs through my mind as I quickly drive to Mom’s home.

It’s not.

Parked in front, an EMS truck’s bright lights flash. A sense of foreboding ripples through me as I rush to the front door. There, three young men appear on the verge of breaking it down. My key slides into the lock; we all rush in.

My mother, on the floor in the living room, leans against the piano. She can’t move. She appears confused. After a quick conversation with the EMTs, I grab pillows and a blanket to give her support and comfort while they get the needed equipment. “Mom, what happened?” I ask. She doesn’t appear to hear my question; I realize that she’s not wearing her hearing aids. I shout “Mom, what happened?” Looking down at her legs in bewilderment she says weakly “My legs gave out on me. They just gave out. I can’t move. I can’t get up.”

She cries out in pain as the EMS crew tries to help her up. It quickly becomes obvious that something’s terribly wrong. “A break?” I think. “But, that can’t be; she’s been on Fosamax for years. Perhaps it’s a sprain.”

The crew checks her vitals, loads her onto a gurney and whisks her to the waiting ambulance. I tail it to the hospital’s ER, with a detour at Starbucks for liquid energy. My husband answers the phone to receive the first of what will be many reports over the next few weeks. “Yes, I’ll be glad to bring dinner,” he says. I’m comforted to know that he will be there soon. It looks as if it will be a long night for us all.

Later, under the dim lights of the ER, a young doctor shows me the X-rays taken on arrival.  Perplexed, he says, “It appears that she suffered fractures of both femurs. Here,” he points to the monitor, “are the zigzag breaks.” He’s never seen anything like this before. We later learn that they were spontaneous breaks, not due to a fall. They “just happened” as she walked across the living room. Or as Mom says now, “I didn’t break my bones, they broke me.” Shocked by what I’m seeing, my turbocharged mind tries to make sense of what happened.

I agonize as I think back and realize that years of using the miracle bone-building drug did nothing to protect her. They say, “Hindsight is 20/20.” That’s a perfect cliché for the “aha!” that slowly dawned on me. How did we miss the obvious? The last ten years had included painful, hairline fractures just from climbing to the Acropolis; an unexplained broken pelvis; a fall that resulted in another femur fracture; a split ankle bone the previous summer that came out of nowhere. And yet, no one questioned the efficacy of this drug. Her doctors kept on prescribing it, oblivious to the evidence that it didn’t work.

But worse, we kept on believing in it. Convinced by the advertising hype—including the well-known ads featuring a cute, middle-aged actress—we failed to examine our firsthand evidence critically. It never entered our minds to question the so-called wonder drug. We were truly hypnotized by the “common wisdom,” even though Fosamax’s ineffectiveness and, yes, potential danger, were staring us in the face for years.

Back to the situation at hand… I’m faced with many questions—in the short-term, myriad decisions about what’s next. My mind drifts back to what brought her here and I can’t help but wonder: “How do I tell her?” How do I tell Mom what happened and that Fosamax failed her? I watch as she rests in the hospital bed, eyes closed, IV and wires sprouting from her body. I still can’t believe this happened to my sweet Mom. Duped by one of the pharmaceutical industry’s miraculous quick-fixes, it proved in the end to be too good to be true. I silently wonder how many other women will experience similar fates.


At 86, she did well to survive the surgery to repair the damage. Afterward, unbelievably, a hospital medical doctor tried to put her right back on Fosamax with the explanation that it was important to keep it going, so her bones didn’t suffer. Huh?  Say what?

My growing questions and suspicions of the drug led to research to double-check what appeared to be obvious: The stuff didn’t work ‘til now, so why should it in the future? As it turned out, an increasing body of information cast doubt on this drug, for some people. A 2008 New York Times article discussed the growing cohort of women who used Fosamax and other “bisphosphonates” (the active ingredient in these drugs) long term, who were experiencing spontaneous breakages similar to my mother’s. Osteonecrosis (death) of the jawbone was determined to be another “side effect.”

Over the next year, my research revealed numerous concerns, which directly relate to a critical core issue: Standard medicine tends to address the body organ-by-organ rather than as a whole system.

A case in point: The treatment for Mom’s atrial fibrillation (it’s onset several years after beginning Fosamax, and a suspected side effect, as documented in the Archives of Internal Medicine and elsewhere) employs Coumadin, also known as warfarin, to thin the blood. This treatment, in the eyes of the medical community, precludes the use of essential nutrients such as Vitamin K, critical to bone heath. “Vitamin K helps the body to make a protein called osteocalcin, which is the magnet that attracts calcium to the bones,” says James Biddle, MD, (board certified internist and member of the American College of Physicians and the American College for Advancement in Medicine). “Furthermore,” he continues, “Vitamin K has also been shown to remove calcium from arterial plaques, and put it back into the bones where it belongs.” But because most doctors are limited in their understanding of nutrition and the relationship of nutrients—or their deficiencies—to health issues, they typically ignore the need for that nutrient and others for bone health. So, when on blood-thinning treatment, doctors instruct patients to avoid Vitamin K and Vitamin K-containing foods such as green, leafy vegetables (also high in calcium). The potential result? Bone loss leading to osteopenia or osteoporosis.

The nutrients from our foods and supplements fuel and feed our bodies. Their presence and quality can make or break our health; or, as in Mom’s case, her legs. Exercise, of course, occupies a close second as a critical ingredient to good health, especially weight-bearing exercises for bone health. Unfortunately, exercise receives much more coverage than does nutrition.

Sometimes—to highlight the need for “systems thinking” in health care—I point out that my mother is not a giant heart beating in a petri dish. Yes, we’re concerned about her heart condition, but she (as a typical human being), presents a complex collection of interconnected organs, which require a balanced approach to make sure all receive the nutrients needed to maintain health of the entire body, not just a single organ.

The point that standard medical doctors seem not to “get,” as in my mother’s case, is that it can be dangerous to treat a condition with what I’ll call tunnel vision, where consideration of the body’s other needs is excluded from the conversation. For instance, bisphosphonates interrupt the process of the body’s manufacture of CoQ10, critical to heart health. Ditto for statins to control cholesterol. Most doctors ignore this and fail to recommend supplementation with oral CoQ10.

In a broader example, an individual may work with several doctors to address different conditions for which multiple drugs are prescribed that may, in fact, contraindicate one another and lead to side effects that require yet another prescription…and so on. Proton pump inhibitors (e.g. Prilosec and Prevacid) present problems such as this, on and off bisphosphonates.

The point: The “left hand frequently doesn’t know what the right is doing,” which can have deadly results. Over 300,000 people a year die from medical mistakes, including side effects of pharmaceutical drugs. How many more die (or have serious complications, such as my mother’s) because doctors ignore the need to address the body’s total needs, in the face of medicines given to treat chronic conditions?

Perhaps a “choir director,” who can coordinate an individual’s medications, nutrition, and supplements to address overall health as well as degenerative disease, is necessary.  There are doctors qualified to do this; they are medical doctors and practice “integrative medicine.” You can visit www.acam.org, the American College for Advancement in Medicine, to locate an integrative physician in your area.

Back to Fosamax. Doctors also prescribe these “miracle” drugs without really knowing the cause of thinning bones. So how does one discover possible causes? DNA testing can examine critical markers that can reveal possible causes and treatments to correct deficiencies. In my mother’s case, testing showed that her two “calcitonin receptors” were defective, and that one D3 receptor was defective.

Without this knowledge, it’s a guessing game. Throwing the drug du jour “at the wall to see what sticks,” in an effort to treat the “disease of osteoporosis” (as the pharmaceutical companies characterize it), feeds the pharmaceutical companies’ coffers to the tune of billions each year, but fails to build healthy bones for some. I’m concerned that the “some” will turn into “many,” then “most” as time moves on. We have yet to see.

Other issues that affect bone health include normal aging (we reach peak bone mass at 25 or 30 years of age), menopause in women, and—less commonly recognized—diet. In my research, diet kept popping up as a contributor.

“The reason dairy products harm your bones is because they acidify the body.”

A major dietary issue is milk products, which the dairy industry in this country touts as necessary for healthy bones. “Our health authorities insist that the calcium triumvirate—drinking milk, eating diary foods, and taking calcium pills—is the best dietary approach to preventing osteoporosis,” says Dr. Amy Joy Lanou (Assistant Professor Health & Wellness Department at the University of North Carolina, Asheville) in her book Building Bone Vitality: A Revolutionary Diet Plan to Prevent Bone Loss and Reverse Osteoporosis. “But, if the calcium theory were correct, we would expect countries that consume the most milk, dairy, and calcium to have the world’s lowest hip fracture rates.

“They don’t. They suffer the world’s highest rates of hip fracture,” concludes Dr. Lanou, with abundant statistical information to support her assertion.

The reason dairy products harm your bones is because they acidify the body. The body automatically tries to normalize its pH. To do so, it extracts calcium from the bones in an attempt to correct the level in your bloodstream.

But dairy products aren’t the only culprits. Sugar and starches contribute to bone loss, as they have to the rise in obesity—at epidemic proportions in this country. These products—found principally in packaged foods, baked items, sugary drinks, and so on—also acidify the body and force the body to extract calcium from the bones to correct the pH balance.

After several months in a nursing home, we took Mom to see my doctor who practices integrative medicine, which unites the best of both worlds of standard medicine and a wide range of cutting-edge natural or non-mainstream alternatives. He suggested the DNA testing, referenced above, which would show what was and was not working in her body—in this case, specifically her bones. This knowledge led to appropriate treatment, along with a complete protocol of supplements such as Vitamin K, D3 (6000 units a day), strontium, and calcitonin. Calcitonin, while a drug with some problems, addresses her specific issue (rest assured, we use it cautiously). Her primary care doctor works with us now to balance the new nutrients, introduced for bone health, with her Coumadin therapy.

In an ironic twist to this story, a bone density test, done just a month or so after beginning her new bone health protocol, showed that she had borderline osteopenia rather than osteoporosis, exactly where she started in the 90s before Fosamax! A conversation with the doctor revealed that while Fosamax might have thickened her bones initially so they had the appearance of denser bone, in the end they became fragile, “dumb bones,” as he called them, leading to the fractures.

I asked why bisphosphonates can, potentially, harm bones. The explanation is a bit technical, but important to understand: Drugs such as Fosamax (generic name, alendronate sodium) work to interrupt bone “remodeling,” which consists of a two-step process of “bone loss or resorption and new bone formation or deposition.” A good, written overview of this process is found in Save Our Bones Program: The Revolutionary Program That Reverses Osteoporosis in 3 Easy Steps by Vivian Goldschmidt, MA.  You see, our bones go through a natural and continuous tearing down and building up process to maintain health. As we get older, the rebuilding process lessens. The Fosamax “solution” interrupts the tearing down process. What happens next? The old bone doesn’t get moved out and very little new bone accumulates after six to twelve months of treatment. What do you suppose can then result? As in my mother’s case, her bones became even more fragile and brittle and, tragically, fractured. The bones may not be thin, but they lose their compressive and tensile strength—the strength and flexibility to resist fractures.

It’s been over two years now since the fractures occurred. Mom’s odyssey continues: A recent surgery repaired a “non-union” of the fracture and, consequently, the broken hardware in her right femur. Its failure to heal properly is yet another, suspected outcome of Fosamax. Although she will still rely upon a wheelchair, we hope physical therapy will help her walk again.

A couple of falls (since her original fractures) left her bones intact. I asked her integrative specialist in 2010 if her bones could have improved that quickly. His response was that although much is still not known about the speed of change in bone quality, he’s seen evidence that resilience can increase fairly quickly. Are her break-less falls supportive of that? We can only hope.

For you, my reader, a recommendation: If you don’t want to end up in a similar situation, take control of your body and bone health. If you use a bone drug and have any pain or discomfort in your leg bones, ask for x-rays or MRIs immediately. If you have a bone scan that shows osteopenia (the precursor of osteoporosis), reconsider rushing into “treatment.” Instead of reflexively accepting medical advice or drugs from doctors, do the research. Find a doctor that can do DNA testing for you to pinpoint what may be causing your bone loss beyond typical aging, diet, or a sedentary existence. Examine your diet and make changes. Start weight-bearing exercises. For your healthy future, take the time to make an informed decision. If you do choose to use a bisphosphonate or other drug, discuss the length of treatment with your doctor. A few months to a year may be adequate.

You’ll find a growing base of information available on bone health. Some helpful web sites and publications include:
Vivian Goldschmidt’s web site www.SaveOurBones.com. Vivian holds a Masters of Arts degree in Nutritional Sciences and Biochemistry and does continual research into bone health. She was diagnosed with osteopenia, told to take Fosamax and drink plenty of milk. She decided to do the research instead, which led her to improving her own bone health naturally, through her diet, and helping others to do the same. Her excellent publications include The Bone Health Revolution: The Complete Natural Bone Health Resource. She also freely shares articles on bone health via email advisories.

Dr. Amy Lanou’s excellent book (with a foreword by Dean Ornish, M.D.), Building Bone Vitality: A Revolutionary Diet Plan to Prevent Bone Loss and Reverse Osteoporosis, is a must-read. The sub-sub title indicates the content: “Why Calcium, Estrogen, and Drugs are NOT the Answer.” Diet is central to her discussion.
Dr. James Biddle, another local, Western North Carolina resource, offers an excellent overview of osteoporosis/bone health on a CD or DVD available from his web site www.docbiddle.com.

Other References:
Archives of Internal Medicine abstracts and texts including:
Vol. 168 No. 8, April 28, 2008—Use of Alendronate and Risk of Incident Atrial Fibrillation in Women, by Susan R. Heckbert, MD, PhD; Guo Li, MS; Steven R. Cummings, MD; Nicholas L. Smith, PhD; Bruce M. Psaty, MD, PhD

Vol. 171 No. 11, June 13, 2011—Proton Pump Inhibitor Use and the Antifracture Efficacy of Alendronate, by Bo Abrahamsen, MD, PhD; Pia Eiken, MD, PhD; Richard Eastell, MD, FRCP

• Geriatrics, January 2009 Volume 64, Number 1—Bisphosphonates and low-impact femoral fractures: Current evidence on alendronate-fracture risk, by Jennifer P. Schneider, MD, PhD. This may be obtained at http://jenniferschneider.com/

 


Susanna Euston is a writer and photographer living in the beautiful mountains of Western North Carolina.

©2011 Susanna Euston. All Rights Reserved.

 

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