Wednesday, February 4, 2009

Triple Jeopardy: Risk of Dying Escalates After Osteoporotic Fractures

A new study has confirmed what we all know anecdotally.

“She broke her hip, and then…” You trail off, because we all know that many elderly people go downhill after a fracture—not always, but often enough.

And the study, published in JAMA (the Journal of the American Medical Association) on February 4, 2009, showed that indeed the risk of dying after a hip fracture more than doubles for elderly women, and triples for elderly men. This premature mortality risk lingers for about ten years after a hip fracture and about five years after a more minor type of fracture—a wrist fracture, for instance, which would increase the chance of dying by about 40 percent during those five years.

Dr Dana Bliuc and A/Prof Jackie Center, head of the Bone Clinical and Epidemiology Research Group at the Garvan Institute of Medical Research in Sydney, based their work on information gathered from the Dubbo Osteoporosis Epidemiology Study. Begun in 1989, this is a longitudinal, population-based study of men and women over the age of 60 living in Dubbo, Australia. 952 women and 343 men with fractures were followed for up to 18 years.

“Our study also looked at factors that drive the premature mortality after a fracture,” noted A/Prof Center in a press release. “Thigh muscle weakness and having a subsequent fracture were important factors in both sexes and low bone density was an additional factor in women.

“The interesting thing is that the increased mortality post fracture does not seem to relate to any other illnesses a person might have.

“Although for most fractures the actual cause of death does not appear to be directly related to the fracture, it appears in time close to the fracture.”

It’s enough to make us fifty-somethings head straight off to the doc for a prescription for Fosamax or Boniva. And then you think about all the side-effects of osteoporosis medications that are constantly hitting the headlines.

Uh oh.

What do you do to lessen the risk of osteoporosis and/or fractures? Medications, or lifestyle changes? If the former, have you noticed any side-effects and do you research the side-effects that other people suffer? If you rely on a healthy lifestyle, how effective has that strategy been for you?

Monday, January 5, 2009

Fosamax May Lead to Cancer for Osteoporosis Sufferers

Ouch. Brittle bones are bad, but are they worse than cancer?

If you have osteoporosis, you may well be scratching your head over the FDA’s recent report that 23 patients taking Fosamax have developed cancer of the esophagus and that eight of them have died. In addition, European and Japanese authorities have reported 21 cases of cancer in patients taking Fosamax and six in patients taking Actonel or Boniva.

Bisphosphonates such as Fosamax are known to cause espohagitis, inflammation of the esophagus, and patients are told to remain upright for at least half an hour after taking the drug. Diane K. Wysowski of FDA's division of drug risk assessment recommends that doctors not prescribe biophosphonates to patients suffering from esophagitis, which is a possible precursor to esophageal cancer.

The news comes especially hard for breast cancer patients who are taking the popular drug to offset the side-effects of chemotherapy.

It’s important to put this news in perspective. According to the National Institutes of Health osteoporosis currently affects nearly 10 million Americans: since 1995 more than two billion prescriptions have been written for bisphosphonates. 50 cases aren’t so many.

Statistically, the risk is small and patients may well be able to offset it by heeding the instructions to stay upright after taking the drug and by taking dietary precautions against reflux.

Share your strategies for avoiding Fosamax’ side effects.