Doctors from Israel describe a 71-year-old woman who developed liver damage 2 months after starting Fosamax, the popular bone-resorption inhibitor, used in the prevention and treatment of osteoporosis and they feel strongly that the drug was the cause or a major contributing factor.
Some of the known side effects of Fosamax are gastric and esophageal inflammation, but renal failure, ocular damage, skin reactions, and hypocalcemia have also been reported.
A case of hepatitis that developed after treatment with alendronate was recently reported in a 77-year-old woman.
The authors admit that the mechanism by which alendronate may cause liver damage is not known, although one possibility is that the fosomax inhibits the synthesis of cholesterol in the liver, which may alter liver function.
Regardless of the mechanism, physicians treating patients with a fosamax or related drugs should be alert to the possibility of liver dysfunction and monitor properly for it.
The New England Journal of Medicine August 3, 2000;343:365-366.
Although this is only a case report and it is likely that the 71 year old woman was highly compromised from other factors, it does illustrate the fact that Fosamax is NOT something that should be used. The report does maintain validity though because the target market for this drug really is 50-70 year old women.
Bone building is a fine balance of a number of factors. Fosamax is very similar to estrogen's mode of action. Estrogen inhibits osteoclasts while Fosamax actually KILLS them. Osteoclasts cells in the bone that actually remove the bone so it can be rebuilt. If these cells are damaged the bone gets much denser. The fallacy in medical thinking though is that a denser bone is a stronger bone.
This is just not true. Even though the bones are denser they are actually weaker because they have not been allowed to remold themselves and readjust to the constantly changing forces that are applied to bones. This will actually increase the risk of fracture over time.
NATURAL Progesterone is normally required to stimulate the osteoblasts or the bone rebuilding cells. The synthetic version, or Provera, does not provide this benefit.
I had previously recommended the cream version of natural progesterone but for most people I cannot recommend this approach any more, as it will in some people cause abnormally high levels of progesterone in the body that actually cause a reverse effect and stop it from working at all.
The optimal solution is to normalize the adrenal glands through a variety of techniques. If a woman still has ovaries they can normally be encouraged to produce appropriate amounts of estrogens and progesterone to build strong bones.
The important tools for normalizing the adrenal glands include an optimal diet, getting to bed by 10 PM and a mechanism for coping with the stress in one's life. Salivary hormone testing is a useful tool to monitor the effectiveness of the interventions.
Exercise and large amounts of vegetables are likely to be more important the mineral replacements. Most people automatically assume that calcium is the most important factor to address bone density. I have seen a large number of women consuming calcium supplements that did not have good bone density as these other issues were not addressed.
Vitamin D is also essential to the formation of strong bones. There is an article that will likely go in next week's newsletter that provides some interesting conjecture that vitamin D should not even really be called a vitamin but is more appropriately identified as a precursor to a steroid hormone. A good mineral replacement however is probably wise.
Magnesium, manganese, zinc, silicon and boron are also important nutrients that should be in the supplement.
If you do decide to take Fosamax, be sure to ask your doctor to check your liver function at regular intervals.