Fosamax Scare: Those With Osteopenia Gauge Risk

The data against testing is persuasive, according to Hadler.

"You have to treat a hundred for a year and maybe you spare one hip fracture," he said. "Most hip fractures are symptoms of frailty. We need more focus on the frailty and the falling."

"Our nation has been taught to fear the consequences of our thinning bones," he said in a 2007 column for

But, he said the reason so many elderly die of hip fractures is because of their "decrepitude -- it's a reflection of their ripe old age. Their time is near."

Dr. Ethel Siris, professor of clinical medicine at Columbia University's College of Physicians and Surgeons and director of the Toni Stabile Osteoporosis Center, said she agrees that not all women with osteopenia should be on bisphosphonates, but the issue is a "complicated" one.

"When we get stuff like this on the news, we get millions of calls and people with bad osteoporosis on the drug and at risk for fractures throw away the drugs and are afraid," she said.

"First of all, these are unusual fractures and hard to interpret and a fair number occur in people without bisphosphonates," she said. "This is a rare complication."

Doctors still don't understand why Fosamax might weaken bones in some women. These atypical fractures tend to occur in women with "low turnover" -- the loss and replacement of bone material.

Bone Quality Declines With Age

Bone density tests fail to capture a poorly understood factor known as bone quality, which declines with age.

Women who have been on a combination of bisphosphonates with estrogen or with steroids like prednisone also seem to be more susceptible to femur fracture.

One theory for these unusual bone breaks is that small stress fractures occur and cannot heal.

"You see the doctor and he doesn't see anything and you keep living with the pain, thinking it's a pulled muscle," said Siris. "You go out there and keep moving and it gets worse and worse. But you probably need to go back for an X-ray or an MRI if you are really worried."

The National Osteoporosis Foundation now recommends women be screened with FRAX, a new algorhythm that gives a 10-year probability percentage for bone fracture.

It is a cost-effect way to evaluate additional risk factors: Did the woman have any fractures after menopause? Does she smoke? Is she small and thin? Does she have a family history of osteoporosis? Is she taking drugs that suppress the immune system and can increase risk?

"If you calculate the risk of fracture and it's quite low and the major factors are quite low, we have a choice [about treatment]," she said.

Five years past menopause "the worst bone loss is behind you," according to Siris. Women who are relatively young with no risk factors might just be advised to take more calcium and vitamin D and get more exercise to combat their risk for fractures.

"The message we are giving people with osteopenia is if you are worried about your risk factor, see a doctor, get FRAX and if the risk is low, don't have treatment and get reevaluated," Siris said.

She also recommends taking a "holiday" from bisphosphonates from time to time.

But she adds, "It's very important not to scare the ones who need these drugs into stopping because they think they are going to get these rare complications."

But for women like Janet Cornish, a retired psychiatric nurse from Maggie Valley, N.C., who broke both her femurs without even falling, she is angry that she never questioned her doctor.

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