Q: Do postmenopausal women with osteopenia, or "pre-osteoporosis", really need to take Fosamax or similar drugs?
A: No. Our medical consultants say skip alendronate (Fosamax and generic) and related drugs if you have osteopenia, or bone density that is lower than normal but not severe enough to be called osteoporosis. While bisphosphonate medications, which along with Fosamax include ibandronate (Boniva and generic) and risedronate (Actonel and generic), can modestly reduce the risk of fractures in people with outright osteoporosis, there's little evidence they help those who only have osteopenia, according to an analysis from the federal Agency for Healthcare Research and Quality released earlier this year.
Even more concerning, all bisphosphonates can actually increase the risk of thigh fracture. They are also linked to other serious side effects, including jawbone damage, ulcers in the stomach and esophagus, eye inflammation, and severe, incapacitating muscle, bone, and joint pain.
Those risks might be worth it if you have osteoporosis because the condition carries a higher risk of fractures. But our medical consultants say it is not worth it if you have only osteopenia.
So what can you do instead? Make sure your diet includes adequate amounts of calcium and vitamin D, which help form and maintain strong bones. Weight-bearing exercise, such as walking or lifting weights, might also help strengthen your bones and reduce your chance of falling. Also, take precautions to prevent falls. That includes limiting alcohol and avoiding sleeping pills if possible. And make your home fall-proof by keeping extension cords out of the way, installing grab bars and rubber mats in the bathtub, and removing or securing loose rugs.
Brittle bones: What to do [Consumer Reports]
Popular osteoporosis drugs come with mounting concerns [Consumer Reports]