Bisphosphonate therapy has been considered standard therpay in the management of patients with osteoporosis, as well as cancer patients with metastatic bone disease. These drugs work by inhibiting the osteoclast-mediated bone resorbption. However, experience with intravenous and oral bisphosphonates has raised concerns about potential side effects related to profound bone remodeling inhibition and osteonecrosis isolated to the jaws, as well as spontaneous femoral fractures, and esophageal cancer.

Two new studies presented at the 2010 conference of the Amercian Academy of Orthopedic Surgeons have added support to the theory that bisphosphonates contribute to fractures, including diminished bone quality after long-term use, and the "potential for the femur to buckle in the hip area." *                          

Since the inital marketing of alendronate (Fosamax) in 1995, the FDA has received 23 reports in which patients have developed esophageal tumors. Another 21 cases have been reported in Europe and Japan. To date, 14 of these patients have died.** The terminal half-life of bisphosphonates in humans is estimated to exceed 10 years. Even after taking one dose of some of these medications, it will take 10 years for it to decrease 50% in the body. The concern is that the side effects will also remain for the next 10 years. ***

Of the medications available for the prevention and treatment of osteoporosis, physiologic hormone replacement is the therapy of choice. Prophylaxis against osteoporosis has been demonstrated with a daily dosage of 0.3mg conjugated estrogens, 0.025mg of estradiol transdermal, or 0.25mg of estradiol (oral or sublingual). A study conducted at PUMC Hospital in Beijing, China, found that bone mineral density and the incidence of bone pain was markedly improved in patients receiving low-dose sex hormones over the placebo group. ****

*www.prleap.com/pr/150158

** www.psa-rising.com/blog/2008/12

*** http://courses.washington.edu/bonephys/opbis/html

**** www.ncbi.nlm.nih.gov/pubmed/15309425