Fosamax, Actonel, Osteoporosis and Toulouse Lautrec by Jeffrey Dach MD
 Fosamax, Actonel, Osteoporosis and Toulouse Lautrec by Jeffrey Dach M.D.Osteoporotic Compression Fractures While working as a radiologist for 25 years, a large part of my day was spent reading X-rays of osteoporotic compression fractures of the spine, which was quite common. These fractures typically involve the mid thoracic spine causing loss of height and curvature of the spine, and considerable pain. Right Image: The modiste Mademoiselle Margouin Year 1900 by Henri Toulouse Lautrec, Musée Toulouse-Lautrec Courtesy Wikipedia Vertebroplasty for Compression Fracture Working in the hospital over the years, I saw many procedures come and go. A procedure called vertebroplasty, still in vogue, is used for treatment of compression fractures. This involves injecting glue into the collapsed vertebral body under x ray control.(1) Prevention Makes More Sense On the surface, it might appear callous for the medical system to wait years until thousands of women develop severe osteoporosis with compression fractures, and then intervene with glue injections. Perhaps some form of prevention would make more sense. The usual preventive recommendation to take calcium tablets apparently was not effective for these women presenting with osteoporotic compression fractures. Perhaps the best preventive plan can be found in Russell Jaffe’s article, Acid-Alkaline Balance and its Effect on Bone Health.(3) Russell Jaffe MD is a charming and humorous fellow who informed our small group of docs at his medical seminar that in the old days he ran a lab at the NIH, and was actually offered the job of Assistant Surgeon General, but he declined the offer after trying it for a day. He is also the founder of a supplement company called Perque.(15) According to Dr. Jaffe's article, excess acid production from the American diet causes the chronic calcium loss leading to osteoporosis.(3) The calcium is pulled away from the bones, and used up as a buffering agent for the acids which can then be excreted in the urine. The solution is to alkalinize the diet, and with the help of alkaline food charts, and pH test strips along with the usual calcium and vitamin supplements, osteoporosis can be arrested and gradually reversed in a process which may take years. I would add that a bio-identical hormone program is also useful for preventing and reversing osteoporosis. Bisphosphonate Drugs and Toulouse Lautrec For the impatient ones who wish to see a prompt increase in bone density, the FDA approved the bisphosphonate drug Fosamax (alondronate) which was first introduced in 1995. Merck made 3.2 Billion on 22 million Fosamax prescriptions in 2006. A major drug study, (FIT) the Fracture Intervention Trial, showed lower fracture rates in the drug group.(4) And it is true that the bisphosphonate drugs will reward the user with a prompt increase in bone density. The main question remains however, how strong is the bone with the increased density? This is an important question because we know from studies of Toulouse Lautrec that his increased bone density was not stronger, in fact his bones were much weaker leading to spontaneous fracture and jaw necrosis. This is explained below.   Image Above: Henri Toulouse Lautrec courtesy of wikipedia, short stature from pycnodysostosis. Genetic Bone Disease What could fosamax (alondronate) have in common with Toulouse Lautrec, the famous French Impressionist artist? One day, Toulouse Lautrec's name came up in conversation, and we puzzled over the cause of Lautrec's short stature. After looking up the question on the internet, we discovered that Toulouse Lautrec’s parents were first cousins giving Toulouse the autosomal recessive genetic disease, pycnodysostosis, which means dense bones. I had seen X-Rays of this bone disease in text books while studying for the radiology board exams, but I have never seen it in actual practice. Dr. Gelb found Toulouse Lautrec's dense bone disease was caused by a genetic defect in cathepsin K, a protease enzyme of the osteoclast cells responsible for removing and remodeling bone.(5)(6) Osteoclast cells are bone cells involved in resorption and remodeling of bone. In this disease, the genetically abnormal bone is very dense on xrays, and yet looking under microscopic examination, one sees profound deterioration in trabecular architecture and lamellar arrangement. This is presumably the reason for spontaneous fracture and jaw necrosis which occurs in Lautrec's genetic bone disease, and also occurs as an adverse side effect of the bisphosphonate drugs.(7)  This osteoclast dysfunction and resulting bone fragility explains why Toulouse had spontaneous fractures of both mid femurs at the age of 12 and 14. The mid-femur fractures never healed properly. The non-healing mid femur fractures caused Toulouse Lautrec to have short stature, attaining a final height of only four and a half feet.(8) Left Image: Spontaneous fracture of mid femur in child with pycnodysostosis. Courtesy of Taylor et al. J Bone Joint Surg Am 60 (8): 1128. Bisphosphonate Mechanism of Action Bisphosphonate drugs (fosamax and actonel) are taken up by osteoclasts, causing disruption of osteoclast activity. The osteoclasts are bone cells involved in bone resorption and remodeling. This loss of the osteoclast activity inhibits bone resorption and bone remodeling, tasks otherwise performed by the osteoclasts.(9) Thus, the bisphosphonate drugs produce a chemical disruption of osteoclast activity same as the genetic disease of Toulouse Lautrec. The bisphosphonate drugs also produce the same adverse side effects, namely jaw necrosis and spontaneous fracture. Questions About Long Term Safety The conventional medical test for bone density is the DEXA bone scan. And, indeed DEXA bone scanning does confirm that bisphoshonate drug treatment increases bone density, and studies such as the FIT (Fracture Intervention Trial) report drug treatments reduce fracture rates in severly osteoporotic women over the short term. However, Susan Ott, MD raises questions about the long term safety of bisphosphonates.(10) Although the bisphosphonate drugs appear to have short term benefits, Dr. Susan Ott speculates that over the long term, after 5 years of use, the drugs cause severe suppression of bone formation, and negative effects such as microdamage and brittleness. Reports of Spontaneous Fractures  Jennifer P. Schneider, MD, PhD reports a 59-year old previously healthy woman on long-term alendronate.(11) While on a subway train in New York City one morning, the train jolted, and the woman shifted all her weight to one leg, felt a bone snap, and fell to the floor, suffering a spontaneous mid -femur fracture (see right image). In the months following, it became clear that the fracture was not uniting.Right Image: Spontaneous mid femur fracture courtesy of Jennifer P. Schneider, MD, PhD January 2006 Volume 61, Number 1 Geriatrics Schneider speculates that increased bone density from the bisphosphonate drug does not necessarily equate with good bone quality. By decreasing osteoclast activity and bone resorption, and therefore bone formation as well, microdamage, and brittle bone may result in fractures.(11) Odvina reports on a series of 9 patients who suffered spontanous fracture while on fosamax (alendonate). Five of the nine cases were spontaneous mid femur fractures.(12) Two had bilateral mid femur fractures just like those sustained by Toulouse Lautrec. Six of the fractures showed delayed or absent fracture healing. Histomorphometric analysis of the cancellous bone showed markedly suppressed bone formation, and Odvina raised the possibility that severe suppression of bone turnover could develop during long-term fosamax (alendronate) therapy, resulting in increased susceptibility and delayed healing of fractures. Dimitrakopoulos report on 11 patients presenting with necrosis of the jaw, claiming this to be a new complication of bisphosphonate therapy administration, i.e. osteonecrosis of jaws.(13) He advised clinicians to reconsider the merits of the rampant use of bisphosphonates. Osteonecrosis of the jaw is a common finding in pycnodysostosis. The bisphosphonates recreate the same clinical profile of spontaneous mid femur fractures, failure of bone healing and jaw necrosis which tormented Toulouse Lautrec. In spite of these widely adverse effects of bisphosphonates, there are four more drugs in clinical trials specifically designed to inhibit cathepsin K, the enzyme defect in Lautrec's genetic bone disease.(14) FDA approval for use in osteoporosis treatment is expected. Excuse me here, but perhaps this thinking needs re-evaluation. In essence, these drugs are creating a population of women with Toulouse Lautrec’s bone disease.  Ironically, women who sustain fractures while on Fosamax are told by their docs that the fractures are due to the underlying osteoporosis, not the drug. For a recent example that I know of, a 60 year old female sustained a fractured elbow after minor trauma at home in the kitchen. She claims that, if not for the biphosphate drug, her fracture would have been much worse. When patients continue to fracture while on the bisphosphonate drugs, the medical system tends to blame it on the underlying osteoporosis, not the drug. Sound familiar? Conclusion: The obvious conclusion is that this entire class of bisphosphonate drugs should be banned, and I predict that they will be banned within the next few years. Remember that you read it here first. If you would like to read more about the bisphosphonate drugs, see this article, Bisphosphonates for Osteoporosis, A Closer Look at the Data by Jeffrey Dach MD. (16) Jeffrey Dach MD 4700 Sheridan Suite T Hollywood Florida, 33021 954-983-1443 www.drdach.com www.jeffreydach.com www.naturalmedicine101.com www.truemedmd.com References (1) http://www.ajronline.org/cgi/reprint/182/2/319.pdf Treatment of Chronic Symptomatic Vertebral Compression Fractures with Percutaneous Vertebroplasty,Daniel B. Brown Louis A. Gilula Manu Sehgal Joshua S. Shimony, AJR 2004;182:319–322 (2) http://www.emedicine.com/RADIO/topic871.htm Vertebroplasty and Kyphoplasty, Percutaneous Article Last Updated: Jul 27, 2006 Jeffrey P Kochan, MD, Associate Professor of Radiology and Neurosurgery, Temple University School of Medicine; Director, Diagnostic and Interventional Neuroradiology, Department of Radiology, Temple University Hospital (3) http://www.betterbones.com/research/articles/bjaffe.PDF Acid-Alkaline Balance and Its Effect on Bone Health Susan E. Brown, Ph.D., CCN, and Russell Jaffe, MD, Ph.D., CCN International Journal of Integrative Medicine Vol. 2, No. 6 – Nov/Dec 2000 (4) http://www.ncbi.nlm.nih.gov/pubmed/8950879 Lancet. 1996 Dec 7;348(9041):1535-41 Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group.Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, Bauer DC, Genant HK, Haskell WL, Marcus R, Ott SM, Torner JC, Quandt SA, Reiss TF, Ensrud KE. (5) http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=9529353 Am J Hum Genet. 1998 April; 62(4): 848–854. Paternal uniparental disomy for chromosome 1 revealed by molecular analysis of a patient with pycnodysostosis. B D Gelb, J P Willner, T M Dunn, N B Kardon, A Verloes, J Poncin, and R J Desnick Department of Pediatrics, Mount Sinai School of Medicine, New York, NY, USA. (6) http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=265800 |
Thanks very much for your comment on "Ordinary Women and Breast Cancer".
I myself was diagnosed in 2000, and so far, so good - no chemo, no radiation, no tamoxifen - but with a lumpectomy, alternative treatments, kinesiology, raw foods, acid/alkaline awareness, thought process changes...
My healing journey led me to a newsletter - My Corner where I share information on health and nutrition and other relevant issues - click here for sample issue.
My current interest is now osteoporosis as, since I have been off the horse urine drug - premarin after my diagnosis in 2000 - I am experiencing bone loss. I refused all the offers and have been working on what you mentioned on your website (great website, by the way) The earlier urine test (about 4 years ago) showed no leaching of calcium/protein etc. But I was talking with an alternative healer who said that I might need progesterone (I stayed away from any form of hormone as the cancer an estrogen receptor) But I bought wild yam formula in Progestera Plus and just recently started using it, with a stronger silica liquid supplement. I also did another urine test and am awaiting the results.
I notice quite a lot of symbiosis in our themes and approaches and wonder if you might consider linking sites.
From "Ordinary Women and Breast Cancer" Blog
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Osteonecrosis of the jaw (ONJ) is painful, disfiguring, and sometimes disabling. Many victims will never again be able to chew solid food.
Symptoms of ONJ include:
· Pain, swelling, and infection of the gums
· Poor healing of the gums
· Dramatic gum loss
· Exposed bone
· Drainage
· Loosening of teeth
· Tooth loss
· Pain or numbness of the face
· Numbness or the feeling of heaviness in the jaw
Eventually those with ONJ may have to have portions of their jawbones shaved down or removed.
Typically ONJ develops after dental work or minor dental trauma. Treatment normally involves long term use of antibiotics, and can require surgery. However, surgery can actually worsen the condition. Stopping the use of bisphosphonates does not always prevent the condition since the drugs can stay in a patient’s system for months or even years.
ONJ is very difficult to treat. ONJ victim require extensive and costly medical care. Those who have developed ONJ after using bisphosphonates may be entitled to compensation which can help pay for the medical treatment they must have, and some may even be able to return to normal life.
by Dan Goldstein
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I took Fosamax for three months.
After gastric reflux brought up some of last dose, I have esophageal irritation and crepitus at breastbone, hands, legs, spine.
I will never take again.
1) Will crepitus go away?
2) Am I at risk for jaw necrosis with 3 month use?
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Dear Kathleen,
As more and more people become aware of the problems with Fosamax, perhaps they will be able to avoid the adverse side effects which you have described.
Although Fosamax can increase bone density on DEXA scan, it actually makes the bones weaker as described in the spontaneous mid-femur fracture cases and the jaw necrosis cases.
Fosamax and the bisphosphonates are just another example of a series of bad drugs brought out by the drug companies in the past 20 years. As David Graham says, "the FDA is incapable of protecting the American Public"
I hope you have a speedy recovery and wish you the best of health in the future.
regards from Jeffrey Dach MD disclaimer
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My mother is 65 and had two spinal fractures in the past year.
She is losing height fast and are still trying to recover from last fracture.
She used Fosamax for the past year but when I read about it causing osteonecrosis i told her to stop using it cause she complained about Jaw pain.
Her bone density is an avarage of T-score of minus 4 which is severe.
They are doing blood tests to see what is causing it, so we are still waiting.
I need some advice on this as I want to make the right decision
Thank you for your time
Kind regards,
George
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Loved your article,"Fosamax,Actonel, Osteoporosis and Toulouse Lautrec"!
I did not know about the artist's bone disease. The parallels between his bone fractures and jaw necrosis and similar symptoms in people taking bisphosphonates are frightening. I agree that this class of drugs should be banned.
I do not agree that excess acid causes osteoporosis because you need acid for calcium absorption.
I used Fosamax for seven months. Now I take strontium citrate and started a blog to post my progress and information about osteoporosis. Please visit and post a comment at http://strontiumforbones.blogspot.com/
BoneLadyFL
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I have started taking strontium citrate and I'm wondering whether you have any findings on intestinal irritation and diarrohea - I am so tender and wondering whether it is the citrate component. I buy this from AlgaeCal in US.
Thanks
Myra in Sydney Australia.
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