Tag Archives: hip fracture

Bone Health and Osteoporosis: Ups and Downs of Bisphosphonates.

Bone Health and Osteoporosis Risks

CrossFit Bone Health and Osteoporosis.
A CrossFit Masters Athlete from CrossFit Bare Cove in Hingham, MA. takes care of her Bone Health.

If you are young you should eat well, not smoke, and get plenty of weight bearing exercise. Preferably starting from birth (which would be moving your little arms and legs.) There is a lot of research going on in Bone Health. We are learning about it at a rapid rate. This is exciting, but it also means there is a lot that is unknown. And our understanding may change. So far, the agreed Major risk factors for Osteoporosis include:

  • Being female (women lose bone at faster rates than men, and have less to start with)
  • Being white
  • Being small-boned
  • Smoking
  • Drinking
  • Poor nutrition
  • Sedentary lifestyle
  • Losing weight
  • Menopause

Bone Health Protection

  • Being black
  • Having a larger frame
  • Gaining weight (but can cause other health problems)
  • Good diet, not smoking, minimal alcohol intake
  • Weight bearing exercise
  • Being on hormone replacement therapy for menopause (but this increases risk of heart disease and breast cancer)
  • Sufficient vitamin D
  • Sufficient calcium intake

Some things are within our control.  Others are not.  If you are having bone loss you should consider taking bisphosphonates.

 

Bone Health and Bisphosphonates

Bisphosphonates are drugs used to prevent osteoporosis (excessive bone loss). Bone is living tissue. It is constantly replenishing and remodeling itself. Visualize a busy sculptor with modelling clay. If your body (sculptor) senses that bone is not under much stress it will stop paying so much attention to it and focus its energies somewhere else. Bisphosphonates block the cells that break down bone. Cells that produce bone are not bothered by bisphosphonates. This leads to thicker bones.

Bisphosphonates can make bone thicker, reducing hip fractures. They can also make bone more brittle. Some people who have been on bisphosphonates have suffered peculiar shattering of bones. Hip fractures are very dangerous, whether you have osteoporosis. Especially for older people who do not heal as quickly as young people. If you are over age 50 there is a 25% chance that a hip fracture will kill. The odds are worse for the elderly and frail. If you are thinking of taking a bisphosphonate drug to prevent osteoporosis you should probably think about the odds of getting a “traditional” hip fracture vs. a bisphosphonate fracture. The odds of getting a bisphosphonate-type fracture are quite small compared to the risk of getting a traditional hip fracture. Easy choice?  Not yet.

Bisphosphonates and other health risks and benefits.

Bisphophonates may improve “bone health”. They are also associated with

  • Cancer of the Esophogus
  • Atrial Fibrillation (this seems to be more of a risk with intravenous administration)
  • Decreased risk of colorectal cancer (Yea!)
  • Decreased risk of stroke. (Yea)
  • Disintegration of the jaw and tooth problems.
  • Making you feel crappy.   If you take bisphosphonates you should sit quietly for 30-60 minutes afterward.  This will reduce the risk of damage to the esophogus.

Bone Health, Bisphosphonates and Duration of Treatment

Your doctor may recommend that you take bisphosphonates for several years (maybe 5) and then stop for a year or two.  You would be monitored during your “vacation” time to see if your bone has stabilized.  If you start to lose bone again, your doctor may put you back on bisphosphonates.

Meanwhile, continue to eat well and exercise.  Think about giving CrossFit a try too.

I hope this helps.

Here are a few references.  There are many more.

Thosani, N., Thosani, S., Kumar, S., Nugent, Z., Jimenez, C., Singh, H., & Guha, S. (2012). Reduced Risk of Colorectal Cancer With Use of Oral Bisphosphonates: A Systematic Review and Meta-Analysis Journal of Clinical Oncology, 31 (5), 623-630 DOI: 10.1200/JCO.2012.42.9530

Kang JH, Keller JJ, & Lin HC (2012). A population-based 2-year follow-up study on the relationship between bisphosphonates and the risk of stroke. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 23 (10), 2551-7 PMID: 22270858

Kang JH, Keller JJ, & Lin HC (2013). Bisphosphonates reduced the risk of acute myocardial infarction: a 2-year follow-up study. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 24 (1), 271-7 PMID: 23152093

Watts, N., & Diab, D. (2010). Long-Term Use of Bisphosphonates in Osteoporosis Journal of Clinical Endocrinology & Metabolism, 95 (4), 1555-1565 DOI: 10.1210/jc.2009-1947