To Your Good Health: Fosamax is an appropriate, albeit powerful medicine for osteopenia

I’m a 65-year-old, overweight woman. I recently had a DEXA scan, and based on the results, my general physician prescribed Fosamax for osteopenia. The first dose created a horrible reaction two days after ingestion, with severe pain in both of my arms, my neck and my legs. I was in absolute agony for two days, then it cleared up. With the next dose a week later, I hesitated, but still decided to take it. Two days later, the reaction hit me again, only worse. I could barely walk, and my energy was so low. I spent four days in bed, except to cry when heading to the bathroom. I had not taken my Lasix prescription for those four days, as I could barely make it to the bathroom. I contacted my doctor, and she discontinued Fosamax. She’s referring me to a rheumatologist. I read that this drug has all my symptoms, plus more, listed under the severe reaction warning. I will not take it again. Also, a friend told me that this drug is not effective for osteoporosis after more than 20 years of drug tests, and I should not have been prescribed this drug, since I have osteopenia, not osteoporosis. Your thoughts?

Alendronate, with the brand name Fosamax, is in the class of drugs called bisphosphonates. These are powerful drugs that should not be prescribed lightly.

They do have the potential for severe side effects. Severe musculoskeletal pain can occur days or months — sometimes years — after starting the medicine.

The Food and Drug Administration has advised prescribers to discuss this possibility with their patients so that the drug can be stopped immediately if it occurs. There are other options available if the person really needs treatment.

Your friend is half right. Powerful drugs like Fosamax are usually not indicated in people who have low bone mass, osteopenia, without osteoporosis.

However, a history of a fragility fracture — breaking a bone from minor trauma that isn’t expected to cause a fracture — can make the diagnosis of osteoporosis, even if the bone density isn’t in the usual osteoporotic range.

A person can have a high risk of fractures for other reasons, and a clinical tool called the FRAX score helps clinicians identify those who might benefit from treatment.

But your friend is also half wrong. When used appropriately, Fosamax and other bisphosphonate drugs are effective at reducing the risk of fractures.

A vertebral body fracture can cause years of pain and be avoided easily, while a hip fracture can be devastating. So, there are very good reasons to prescribe these medicines.

Finally, let me warn readers against complacence in treatment with these drugs. They may be appropriately prescribed for a high-risk person, but most people should not stay on this drug forever.

Follow-up DEXA scans should guide therapy, and after three to five years, a conscious decision should be made whether to continue therapy.

Readers who have been on these drugs for more than five years and haven’t had careful follow-ups on their results should ask their doctors whether they still need to be taking them.