Fosamax (alendronate) is a bisphosphonate medication used to treat and prevent osteoporosis. It works by inhibiting bone resorption, which is the process where bone is broken down and its minerals are released into the bloodstream.
Here’s how Fosamax can influence Dexa (Dual-energy X-ray Absorptiometry) scores, potentially "faking" an improvement:
Increased Bone Mineral Density (BMD): Fosamax helps increase bone mineral density by reducing bone turnover, particularly by decreasing the activity of osteoclasts (cells that break down bone tissue). As a result, Dexa scans, which measure BMD, may show an increase in bone density.
Reduced Bone Turnover: The medication stabilizes the bone remodeling process, leading to less bone being resorbed and more being retained. This can make the bones appear denser on Dexa scans even if the bone quality hasn't significantly improved.
Short-term vs. Long-term Effects: In the short term, Fosamax can lead to noticeable improvements in BMD, which are reflected in Dexa scores. However, this doesn't necessarily mean that the overall quality or structural integrity of the bone is vastly improved. Over time, the suppression of bone turnover could lead to older, potentially more brittle bone being less frequently replaced by new bone.
In summary, while Fosamax does genuinely increase bone density as seen in Dexa scores, this doesn't always correlate directly with improved bone quality or reduced fracture risk. The Dexa score improvement might thus be seen as "faked" in the sense that it reflects increased density without necessarily indicating a proportionate increase in bone strength or quality.
Just thought I'd share this reply. My doctor prescribed this for me last year. I took three doses and stopped. I have acid reflux and this is not the best choice. But after looking more into the medication and the side effects, I knew it wasn't for me. Right now I am just sticking with doing my weight bearing exercises, taking calcium citrate and vitamin k2. My next scan is this August. Hoping there is an improvement. But if there is not, I still am hesitant about starting any medications. Once you start medications it is for life and I am only 64, very active and not ready to take this route. My mom was 83 before she passed away and never broke a bone.
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Great idea to ask AI! I have heard this about Fosamax and have avoided all the O medications so far. Like you I am focusing on weight bearing exercises and some yoga instead and my last DEXTA did show an improvement. I am also on a very low dose hormone which helps retain the bone I gain. I started this when I was 59 now 63 and it's been good.
Tiborone 1/2 tab-It's designed for menopause and not an HRT exactly. At 1/2 strength it helps to prevent bone loss while maintaining normal bone turnover. It is not available in the US yet used widely in Europe and Australia.
Thanks for the article, it has been known for some time that fosamax creates dead bone which appears denser on the Dexa,the doctors are yet to catch up
Great idea and thanks for sharing. Pretty much what my research demonstrates about these meds. It's the brittle bones that are the result of meds that lead to fractures. My mom did all the meds as the protocol dictates. After decades on them, in her mid 80's she began to fracture yearly different bones and now has a hump.
this is interesting answer from AI and furthers my choice to not take these meds. Needs to be more work done on side effects vs presumed gains. Mother aged 96 only had 1 broken bone from a fall when she was 90- had osteoporosis from age 65.
it is true that bisphosphonates slow down bone destruction and also bone creation so over time the bone is ‘older’. However the problem is one of when to use these meds and when not to. The DEXA is a good baseline and maybe all of us should have a baseline DEXA ages 50 - whether we have any osteoporosis or not. We could then take actions to reduce risk.
The use of bisphosphonates like fosimax however can be useful if your are at risk on several measure of major fracture, also if you can’t do the required weight bearing exercise and it have other issue that may increase risk it’s worth considering treatment in full discussion with your physician. Also having bone marker blood test before you start (CTX/P1NP).
The risks of ONJ and atypical femoral fractures is increased after 3-4 years continuing use. Though both are rare.
Having a break from the bisphosphonates based on if they have work can be often what is recommended to reduce risk. Many have often just continued though for years.
Serious bone loss is in itself a major cause of impairment and mortality especially after a hip fracture in elders.
Worth a note that when the scares around these medications came to light and many in the USA stopped or refused treatment with them the incidence of hip and other fracture and mortality went up !
This is the AI GTP answer to the impact of patients stopping or refusing treatment with bone meds such as bisphosphonates :
1.increases fracture rates
Several studies have shown that the decline in bisphosphonate use has been associated with an increase in hip fracture rates among older adults. Hip fractures, in particular, are a significant concern as they can lead to severe disability and increased mortality.
2. Rebound Effect: Patients who stopped bisphosphonate therapy experienced a rebound effect, where their risk of fractures increased after the protective effects of the medication diminished.
Impact on Mortality
1. Higher Mortality Rates: Increased fracture rates, particularly hip fractures, have been linked to higher mortality in older adults. The rise in hip fractures likely contributed to an increase in fracture-related mortality, considering the significant morbidity and mortality associated with these injuries.
So all quite nuanced and bisphosphonate use isn’t all bad and side effects uncommon- we are all individuals and so investigate but don’t be impacted by ‘individual’ horror stories as those who have had no problems never report it. Rely on research and individual circumstances and health history
I agree that these medications help a lot of people and many do not have side effects. I just don't like the idea of something remodeling old bone. Once you start Fosamax, you have to be on something all your life so you don't have rebound fractures. Many people do stop taking it and that's why they have problems. I hope they can come up with better alternatives for us. I know there are a lot of meds that do build new bone too. You're right, everyone has to do their own research and figure out what is best for them in their situation. Thanks for your input.
I think that it isn’t true that you can’t come off fosamax ( alondronate) - that is a bisphosphonate and the issues with stopping getting a rebound that you lose what you held is true of prolia and the other monoclonal meds, not bisphosphonates!
Fracture risk reduction may also persist for years after treatment has stopped. The optimal duration of therapy with Fosamax has not been established. Periodically re-evaluate the need for therapy. Discontinuation of therapy should be considered by doctors after 3 to 5 years in patients at low risk of fracture.
I was always under the impression that once you start meds they should not be discontinued. I guess it would depend if you are at a higher fracture risk to continue on meds beyond 5 years. I have read people having issues when they finish treatment. I have also read positive things. For me, Fosamax is not an option.
It is true for Prolia but not for bisphosphonates. I was on Risedronate, which is a bisphosphonate too, for 5 years then had a "drug holiday" as apparently it is not effective after 5 years. Have not been on anything since I stopped it.
Well, I have not yet seen any accurate information come from any ChatGPT or related products...but this is dead on accurate. It's not a change for the positive quality, in fact, it can create a potential bad fracture situation. It also cannot measure bone strength. My doc is pushing a follow-up to Tymlos, and I keep telling her to clear with my surgeon...she knows he is right, they are dangerous if bones are healing from fractures and fusions...so she's just being quiet right now, I have another 9 months on Tymlos. I've had 10 spinal fractures, so it's a hard come back right now.
Great to see the discussion so far, it is true that DXA scanning measures the amount of bone tissue and rather than bone quality. However, using DXA alongside other risk factors that affect your bone health works well to identify those people with a raised risk of fractures and who may benefit from a drug treatment. For more info - theros.org.uk/information-a... and we have a DXA factsheet available strwebprdmedia.blob.core.wi...
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