Alendronic Acid – Take a break!

Take a break to prevent a break!

“Don’t use it for more than five years!”

We recently came across this article about the long term effects of Alendronic acid and thought we should bring it to your attention.  The long and the short of it is that it is not a good idea to use the drug for periods of longer than 5 years,  as it has the effect of making your bones go brittle and actually causing breaks.

Naturopath,  Jacob Schor, ND, FABNO,  writes:

“The drugs that have been used with apparent success to treat osteoporosis may now have a problem. Alendronate may weaken bone and lead to increased fracture risk.

Alendronate is the drug we know as Fosamax. It belongs to a class of drugs called bisphosphonates. These chemicals were developed in the 19th century but were not investigated until the 1960s for bone metabolism. Their non-medical use was to soften water in irrigation systems used in orange groves. The rationale for giving them to people is that they prevent the dissolution of hydroxylapatite, the principal bone mineral, so stopping bone loss. Only in the 1990s was their actual mechanism of action explained when Merck brought Fosamax to the market place.

There is little doubt that these drugs do what they are supposed to over the short term: they increase bone density and decrease fracture risk.”

“From the first use of these drugs, there was always a theoretical worry. Recall that there are two main processes that occur constantly in the bone: osteoclastic activity that breaks down old bone, and osteoblastic activity that builds up new bone. This constant turnover of bone maintains healthy and strong bone. These drugs stop the osteoclastic activity so that the old bone is left untouched. This increases bone density measurements. The worry was that because these drugs halt normal bone turnover people using them would end up with dense but more brittle bones. As the early studies consistently showed a rapid reduction in fracture rates, this concern faded.

These early worries unfortunately were not just a product of naturopathic paranoia; the problems just took a few years to show up.

The May/June 2008 issue of The Journal of Orthopaedic Trauma published a report on “Low-energy femoral shaft fractures associated with alendronate use.” The authors reviewed records of 70 patients who had sustained low energy femur fractures. That means their femurs broke without any major stress. Rather they did little things such as walking or stepped off a curb and thus triggered the breaks. These weren’t young people, their average age was about 75. Of these 70 patients, 25 of them, a little over a third (36%), were taking Fosamax. Nineteen (76%) of those 25 patients demonstrated a simple, transverse fracture with a unicortical beak in an area of cortical hypertrophy. This is a rare and peculiar type of fracture. Only 1 patient of those not taking Fossamax (2%) had this kind of bone break. When the statistics were worked out, the numbers tell us that Fosamax use significantly increased risk of these fractures: the odds ratio was 139.33, 95% CI [19.0-939.4], P < 0.0001). You can say those taking Fosamax were about 140 times more likely to get one of these rare fractures. It took about 7 years for this problem to occur. Those taking Fosamax less than 2.5 years were not at greater risk.

A 2009 paper in Geriatrics continued this story. It tells us that, “The fractures are often preceded by pain in the affected thigh…” this paper suggests that patients not take Fosamax for longer than five years. Another 2009 article, this one in Clinical Calcium, echoed this warning and suggested that, “… alendronate treatment might be stopped for a while after 5 years to prevent [these kinds of]… fractures.”

Few doctors and fewer patients are paying attention to duration of Fosamax use. Most patients will report they’ve taken Fosamax, “for awhile.” We need to start spreading the message, “for awhile” should be less than five years.”

“In our practice we are suggesting a break from use after a shorter period of time, about three years. Discontinuing Fosamax use and relying solely on naturopathic treatments even for an interval of time, may, in the long run prove to be a safer course of action.”

For the full article and links to the relevant research:

18 thoughts on “Alendronic Acid – Take a break!

  1. I mentioned this to my aged mother who has bad osteoporosis and this is what she says. “There’s been a lot of discussion about this in the Osteoporosis News and I have already warned my friend Jane about it who has been on the drug for 8 or 9 years. She has discussed it with her doctor who has taken her off it. I have been on it for 3 and a bit years. When the time comes I shall certainly discuss it with my doctor and I’m sure she will agree. On re reading I see it suggests 3 years in one place, so maybe I talk to her before. Believe me I am very aware of the problem.” Personally I think for birdshot sufferers, Alendronic Acid perhaps only needs to be taken when on high doses of steroid, and not for elongated periods of time, because from what I have read, it is at the high doses of steroids that the damage to bones is most likely to happen.

    If this concerns you at all, please ask your doctors for their advice. Perhaps, we should all be trying out the weight bearing (housework and exercise) carrying weights (bottles of water in a rucksack) since this also helps to build up bone density and can do no long term damage to bones. What is more it is free!


    • I Have been taking those tablets for over 12 years and on 21st December 16 . My hip just broke getting out of the shower .
      My hip had been hurting for a couple of years before this , and doctor was treating me for arthritis with creams and pain killers .
      I only became aware of the dangers of taking the drug For a long period of time , last week when I visited the fracture clinic .
      I am very annoyed that no one has ever brought the subject Up before . This break could have been avoided ! Due to this break , I ended up breaking my ankle on the other leg at same time . Having to stay in hospital for seven weeks !!
      ( who do I blame for keeping me on these tablets ) ?

      • Sorry to hear this Sandra Jones. It has only just really surfaced into general medical practice that it is not a good idea to take alendronic acid for long periods of time, but what to do the consequences of osteoporosis are quite devastating and painful as well.

        • 5 months on , and I am still walking with a walking stroller when I go out . And a heavy stick around the house .
          I am so scared that something else is going to break !
          I have asked my doctor for an X-ray On my other hip to see if that is damaged . Also another bone dentisy scan to see if damage has been caused through taking this drug. I am still waiting for a reply from that request. Please warn everyone. They need to know. Also I have read in other reports that the drug takes 10 years to get out of your system !! Is that also true ??? Thank you

          • Sandra its a bit of a catch 22 isn’t it. Keep pressurising your GP to make sure you get seen by an expert to see what can be done about your bones if they have become brittle.

  2. Thanks Annie, I have been on this drug for 2.5 years now and am only on 5mg of steroid a day at the moment, I will certainly mention this next time I go to the Hospital.

  3. I had a chat with the doctor I see who does my bloods at the local renal unit. She advised me that the time to really worry about bone density being reduced from steroids, was when you are on high doses. I talked to my ophthalmologist as well and decided to stop taking the alendronic acid unless I have to go back on high dose steroids, when I will obviously need to reconsider.

    It’s so difficult to know whose advice to follow! All the best. Annie

  4. I hae been taking alendronic acid for nearly 5 years. Beacause of the tightness in my chest, the doctor has prescribed 40mg of omeprazole to counteract the side affects of alendronic acid affecting me. I also take Femera(Letrozole) to decrease the oestrogen feeding breast cancer. Is it time to come off alendronic acid?

  5. I was very shocked to read this article as both my wife and I have been on alendronic acid for at least 10 years. Recently we asked one of the doctors at our group practice for a DXA scan as it has been over two years since our previous bone density scan. We were both told that it was not necessary as scans were only needed every five years. Today my wife was discussing her hair loss with her hairdresser and it was suggested to her a side effect of medication may be the cause and I found this site as a result of searching the internet.

    Perhaps we need to change our GP practice.

    • I have been on Allendronic Acid since 20 years now. My GP has never suggested or talked to me about stopping the drug. I too had regular dexa scans until recently when I reminded my GP that I was due for another one he said is not needed. With other words we know you have Osteoporosis (correction they call it now Ostepeania as my age has caught up with my bones).
      I have also learnt the hard way that when you have a tooth extraction it can give you considerable problems with your gum afterwards.
      I have been recently diagnosed with an Ovarien Cyst and wonder now if there could be a connection. Can anyone help?

    • Hi John. I am also finding that my hair is getting thinner at an alarming rate. I was never told by my GP or anyone else dealing with my case.I only discovered this side effect from looking at websites. I am now stopping from taking it and hope to God it will stop it but better still get my hair back to what it used to be. You put your life in the hands of people who are supposed to know what they are talking about. I get more help from my chemist.

  6. Does anyone have any idea about how long the drug stays in the system?
    I have taken ONE dose of alendronic acid and within 2/3 days developed an intensely itchy, ugly, swollen rash, especially, not exclusively, on both sides of my hands, my upper arms my feet and my thighs. I have been prescribed umpteen creams and ointments as well as sedatives and antihistamenes with and steroids but none have alleviated my symptoms.

  7. From what I have been told by my doctor, I have a feeling alendronic acid stays in the system for sometime but this was said to me in relation to taking it for an extended period of months rather than just one dose. You could ask your pharmacist if he knows. I have not heard of this side effect from it before. Annie

  8. I spoke to my pharmacist re that problem. I took AA for 5 or 6 years and suffered excruciating pain in my left femur before it was discovered what had caused it. A steel pin inserted in the femur resolved the situation but now my right thigh is giving me some discomfort and I wonder if that is the same . I stopped AA in about April this year which is 8 months ago. The pharmacist said it would only stay in the system for about one or two months at the most but I am still not sure.
    Advice welcome.

    • Daphne, sorry we do not know the answer to this Question, but I do know my dentist carried on being concerned about the fact that I used to take Alendronic acid for quite a while, certainly longer than two months. Sorry not to be able to help.

  9. I have taken alendronic acid for 20 years with no problems but was recently called for a bone density scan and taken off it. During the
    Appointment the nurse took a blood sample because I’ve been on it for
    So long and now I have to attend on 19th Jan 2017 as there is a protein in my blood “which requires investigation” Can there be a problem.???? I am a bit anxious as to what is wrong!!!

  10. I have taken AA for over 10 years, it has now been stopped for what my doctor calls a “drug holiday”. I am concerned because he has not told me how long this holiday should last for and I had spine fractures three years ago. I am 70 years. Any advise welcome

    • We believe that the best idea is to make sure you have enough vitamin D and calcium as this helps with bone health, and do some weight bearing exercise if you can. I realise this might be difficult if you have had spinal fractures and I also know how painful these can be as my mother suffered from them. In the end she received an annual infusion which seemed to work, ie no more cracked vertebra, but I am not at all sure if the drug they use in the infusion works in the same way as alendronic acid or not. You could ask your GP if you could be considered for this, but may find it difficult to get a referral but worth a try if you are worried.

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