Osteoporosis Drugs May Weaken Bones

Bust made of bones

A report on BBC Radio 4’s Today programme today highlighted new research which suggests that drugs used to treat weak bones in elderly patients suffering from osteoporosis may actually make them weaker.  Below are key the key points from an accompanying article on the BBC website

Scientists at Imperial College London examined the bone structure of hip-fracture patients who had been treated with bisphosphonates.  They found evidence the drugs were linked to microscopic cracks, making bones more fragile and prone to break.

Osteoporosis affects three million people in the UK.  Losing bone is a normal part of the ageing process, but some people lose bone density much faster than normal. This can lead to osteoporosis and an increased risk of fractures.

Bisphosphonates – the main treatment for osteoporosis – are a commonly prescribed class of drugs that slow down the natural processes by which the body removes ageing or damaged bone.  But doctors have raised concerns about the number of fractures occurring among elderly patients who have been taking the drugs for a long time.

To find out why, the team led by Dr Richie Abel took samples of bone from 16 hip-fracture patients and studied them at the Diamond Light Source – the massive doughnut-shaped Syncatron or particle accelerator at the Harwell campus in south Oxfordshire.

“What we wanted to see was whether the bone from bisphosphonate patients was weaker or stronger than bone from untreated controls,” Dr Abel explained.

“Rather startlingly, we found the bone from the bisphosphonate patients was weaker. That’s a conundrum because the bone should be stronger.”

Animal bone sculptures by Hideki Tokushiga

By bombarding the samples with X-rays 10 billion times brighter than the Sun, the team were able to generate images of the internal structure of the bones in unprecedented detail.  These showed microscopic cracks building up in the bones of patients treated with bisphosphonates.

Dr Abel said: “The drug is clearly working, but it also leads to the build-up of micro-cracks in the bone and that could increase the likelihood of a fracture.”

It’s a surprising result, but the study was small and the work is at an early stage.  Even so, Professor Justin Cobb, a co-author on the paper, says the discovery raises important questions about how we prescribe bisphosphonates for long-term conditions such as osteoporosis.

“There’s no hurry, but we should think about how long people are taking them for, and how we might monitor the development of these micro-cracks,” he said.

In the meantime the researchers say people should continue to take medications prescribed by their doctor.

A good diet rich in calcium and vitamin D, maintaining a healthy weight, avoiding smoking and alcohol, safe exposure to sunlight and regular exercise involving some weight bearing activity are also highly recommended for good bone health.

To close, here’s Shakey Graves (swoon!) with a cover of Rush’s Roll the Bones…see what I did there…

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