Reports of drugs causing jawbones to rot and thighbones to snap have frightened many osteoporosis patients so much that they say they would rather take their chances with the disease, according to an article in The New York Times. Recent data show that use of the most commonly prescribed osteoporosis drugs dropped by 50% from 2008 to 2012.
Half of patients who start taking osteoporosis medications––such as alendronate, ibandronate, risedronate, and zoledronate––stop within a year, the Times says. In 2011, only 20% of patients discharged from a hospital with a broken hip had a prescription for one of the drugs, compared with 50% in 2002.
After reports of the troubling adverse events surfaced, the FDA requested that the labels of osteoporosis medications include a warning about the association, even though the events are extremely rare. It has been estimated that 10 to 40 in 100,000 osteoporosis patients taking the drugs have sustained broken thighbones. Fewer than one in 100,000 have experienced jaw osteonecrosis.
Physicians had high hopes for an investigational drug, romosozumab, which appeared to avoid the adverse effects of standard osteoporosis treatments, but their enthusiasm waned after Amgen reported the same problems of broken bones and jaw osteonecrosis.
Osteoporosis patients are right to worry about hip fractures, the Times points out. Those injuries are often the start of a downward spiral for older adults. Many never walk normally again, and many end up in nursing homes, unable to care for themselves.
It’s an uphill battle trying to persuade people to take their osteoporosis medications, Dr. Steven T. Harris, a specialist at the University of California, San Francisco, told the Times. One issue, Harris said, is the promotion of diet and exercise for patients with fragile bones, which, he said, is insufficient to protect them from fractures. It gives people a false sense that they can control their risk.
Another issue, according to Dr. Ethel S. Siris, an osteoporosis expert at Columbia University, is that the commonly used osteoporosis drugs are now off patent, and there is no longer an aggressive advertising push to make people aware of them. The cost of these drugs ranges from less than $10 a month for alendronate pills to approximately $1,200 for a once-a-year infusion of zoledronate.