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Anti-Osteoporosis Drugs May Recreate Industrial Scourge, Says Researcher

Anti-Osteoporosis Drugs May Recreate Industrial Scourge, Says Researcher

Picture of Martha Rosenberg

Bisphosphonates, to prevent postmenopausal osteoporosis, have been linked to jawbone death (osteonecrosis) and atypical fractures. Recently, Dr. William Banks Hinshaw, a gynecologist and chemist in North Carolina, likened their effect to an affliction seen 100 years ago.

Rosenberg: You recently co-authored two scientific papers about the biochemical actions of bisphosphonate bone drugs such as Fosamax, Boniva, and Actonel, and Reclast. In one paper [in the January issue of ACS Medicinal Chemistry Letters] you and your co-author suggest the same negative bone effects now emerging with the drugs date back to a disorder seen during the industrial revolution. In the other [in December's Journal of Clinical Endocrinology & Metabolism] you and your co-authors examined 81 patients who experienced fractures, sometimes four or five, on the drugs.

Hinshaw: 150 years ago, people who worked around white phosphorus in factories where matches were made in the US and Europe sometimes developed "phossy jaw" (osteonecrosis) and thigh bone fragility similar to bisphosphonate effects we see today. The chemical culprit is likely to have been a substance in the white phosphorus smoke that inhibits an enzyme involved in the process of bone remodeling and bisphosphonates happen to have been innocently developed as synthetic versions of that substance. I have researched this extensively, including US Army reports about white phosphorus smoke which was shown to include large amounts of the same substance.

Rosenberg: Why would drugs with such an undesirable safety profile be so popular?

Hinshaw: The bisphosphonates are a very polarizing class of drugs. The enthusiastic industrial support of the clinical trials has created a cadre of dedicated bisphosphonate supporters, convinced that the presumed benefits outweigh any possible risk. Despite a trend toward less use (for which I credit the good sense of the patients) Fosamax, in its cheap generic form [alendronate] is still the most prescribed drug for postmenopausal treatment or prevention of osteoporosis. Because of its attractive price, it is still the first choice of the insurance companies who pay for the drugs, and there is no evidence that this is going to change any time soon.

Rosenberg: Clinical trials of bisphosphonates has been impeded by the difficulty in finding women who don't have the drug in their system. How long do the drugs remain in the body?

Hinshaw: Bisphosphonates are nonmetabolizable, resident drugs that never completely leave the body--never. After treatment stops, the burden decreases but there is no point when the resident molecules can be expected to be completely gone. They are not found in circulating serum (except temporarily with an injectable bisphosphonate like Reclast) because they attach so rapidly to calcium/bone. When they happen to be released from one cache, they can be “recycled” into others. They have such a strong attachment to calcium that patients who swallow calcium supplements when they take bisphosphonates, against directions I may add, may be doing themselves a favor -- because bisphosphonates will bind to the calcium instead of their bone.

Rosenberg: There have been media reports, particularly National Public Radio, of the bone density craze and the term "osteopenia" -- the risk of thinning bones -- as being concocted by the drug industry to sell drugs.

Hinshaw: The risk of fracture from fragile bones exists for some individuals, but I think the selling of bisphosphonates is a prime example of disease mongering. My wife, with whom I share a gynecological practice for women of menopause age, and I have not prescribed them since 1998 when it became apparent to us that their action does not make sense metabolically or chemically. They suppress bone remodeling as if bone remodeling were the "bad guy" in osteoporosis and doesn't have the purpose of renewing and strengthening bone. They create a temporary improvement in the balance between bone loss and bone formation which are normally linked--but in a short time bone formation is suppressed, too.

Martha Rosenberg is a health reporter whose food and drug expose, Born with a Junk Food Deficiency (Prometheus Books, 2012), was named in the American Society of Journalists and Authors 2013 Outstanding Book Awards. A former medical copywriter and medical school lecturer, Rosenberg has appeared on CSPAN, National Public Radio, the Ed Schultz show and RTV. "Born" has been praised by Library Journal, the Public Library of Science and cited by the Sloan-Kettering library. Rosenberg spoke at the Mid-Manhattan Public Library in June.

Image by UrbaneWomenMag via Flickr

Comments

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my mom has been diagnosed with osteoporosis and has 10% chance of fracture of her hip bones in 10 years. if all these drugs are so dangerous and not helpful, then what would you recommend? she been taking calcium/vitamin D supplements for years. thanks.

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Prolia for me was a horrible drug! The side effects were awful, I would not recommend Prolia to anyone. I unfortunately did not look up the side effects before taking Prolia and I trusted my doctor. The muscle pain, joint pains became unbearable. I had almost all of the worst side effects of Prolia. I no longer take it and would recommend Fosamax not Prolia. It was initially developed for Bone Cancer patients! As I stated, it was a brutal drug for me and my body may never be the same again. I have confirmed this with three of my doctors and they agree! I also reported it to the FDA!

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Prolia should be removed from the market! I would not recommend Prolia to anyone. My mother was given this drug and has been sick ever since with almost every bad side effect. Unfortunately we were not made aware of what she would be given so we could research the item. After reading this article there is NO WAY we would of allowed it. These drug companies need to be stopped and HELD RESPONSIBLE for their products. I believe this drug has taken years from my mothers life expectancy.
How long are these side effects going to last, we are going on 5 weeks now.

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I am a woman, 68, weight 132 pounds, in excellent health, had 2 separate fractures in past 6 months (spine &elbow fracture), bone density 2.5, mother had osteoporosis. My doctor (also 2 other doctors) wants me to start Prolia right away. Have appointment in February at Mayo Clinic Endocrinology department, for a 2nd opinion from an expert in his field. After reading the harmful side effects of Prolia and reading many scholarly articles, how should I manage my osteoporosis and treatment to increase my bone density??? Who can I trust??? Thank you for your comments.

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