Steroids inhibit the formation of new bone. The mechanism by which this happens is very different from the mechanism whereby postmenopausal osteoporosis occurs. It has not been determined that bisphosphonates with their action of suppressing bone remodelling are appropriate for individuals in this category. The only trials conducted on men and women using glucocorticoids found that overall there was no significant difference in the incidence of vertebral factures between the alendronate (Fosamax) and placebo groups, and a “difference of borderline significance between those [postmenopausal women] receiving alendronate and those receiving placebo”. The incidence of nonvertebral fractures was identical in the alendronate and placebo groups. The most common sites were the ribs and forearm. Although alendronate was found to significantly increase bone density, it appears to offer very small even non-existent fracture benefit to individuals in this category.This type of osteoporosis brings high fracture risk. The lack of fracture benefit must be considered alongside the inconvenience, the costs and risks of taking this drug.
Alendronate Risks:
Because alendronate and other bisphosphonates suppress normal bone remodelling there are concerns that long term use may result in brittle bones. In the absence of long term studies to provide reassurance on this point, we still do not know whether alendronate will reduce or increase the risk of fracture in the long term. New evidence links the drugs with increased micro-fracture, osteonecrosis (bone death) of the jaw, and spontaneous fractures displaying delayed healing.
The duration of physiological effect is still unknown. Bisphosphonates are long-acting and known to stay in the body indefinitely. The amount of drug within the bone will accumulate with use thus continuing its effect for better or worse. There is no known method of removing the medication from the bones.
Low bone density is frequently identified in younger people. Bisphosphonate studies in animals show foetal and maternal abnormalities in bones and calcium metabolism, Alendronate should not be prescribed to pregnant women or women who might become pregnant while the bisphosphonate is still in the bones. Careful consideration must be given to the risks vs benefits of use in this population.
Black, D.M., Cummings, S.R.et al. ‘Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures.’ Lancet 1996;348:1535-41
Boonen,S., Laan, RF., Barton I P., Watts, NB. Effect of osteoporosis treatments on risk of non-vertebral fractures: review and meta-analysis of intention-to-treat studies Osteoporosis International Published online: 29 June 2005Siris ES, Chen Y-T, Abbott,TA, et al. Bone mineral density thresholds for pharmacological intervention to prevent fractures. Archives of Internal Medicine 2004; 164:1108-1112.Wysowski DK, Chang JT. Alendronate and risedronate: reports of severe bone, joint, and muscle pain. Arch Intern Med. 2005 Feb 14;165(3):346-7. Ott SM. Long-term safety of bisphosphonates. J Clin Endocrinol Metab. 2005 Mar;90(3):1897-9.
Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL. Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg. 2004 May;62(5):527-34.Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, Pak CY. Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab. 2005 Mar;90(3):1294-301.Ott SM. Ibid. Ott, Susan MD. “Osteoporosis and Bone Physiology”.
http://courses.washington.edu/bonephys/ opop/opdem.html
Saag et al. Alendronate for the Prevention and Treatment of Glucocorticoid-InducedOsteoporosis New England Journal of Medicine 1998; 339:292-299
