Question:

I am 59 years old; had a total hysterectomy at age 32. I have continued with HRT (.025 Vivelle-Dot) and the past 5 years 70mg Fosamax, along with Vitamin D. My last bone density test indicated no additional bone loss from the previous (2 years ago) test results.

I’m wondering if a break from Fosamax would be advisable. My physician simply leaves that decision to my discretion. I feel great, have no complaints but I don’t want to take a drug if it isn’t truly necessary. Your response will be greatly appreciated.

Answer:

Fosamax (alendronate) is a medication indicated for both the treatment of osteoporosis and also the prevention of osteoporosis in postmenopausal women. It works by inhibiting cells that break down bone, which slows bone loss. It has also been shown to increase bone mineral density and reduce the risk of fractures.

The optimal duration of treatment with Fosamax in postmenopausal women is unknown. Furthermore, little is known about the long-term side effects of Fosamax therapy. Studies have shown that bone mineral density continues to improve throughout ten years of treatment with Fosamax, however, reduction in fracture risk has only been proven to occur throughout a four year treatment period.

After five years without Fosamax therapy, significant bone loss has been shown to occur at the hip and top of the femur. However, bone density in the lumbar spine remained increased.

An individual’s risk of fracture should also be taken into account when deciding whether or not to continue therapy with Fosamax. History of fracture, low body weight (<127 lbs), current smoking, use of oral corticosteroid therapy for more than 3 months, impaired vision, dementia, frailty, recent falls, lifelong low calcium intake, low physical activity, estrogen deficiency at less than 45 years of age, and more than 2 alcoholic drinks per day can all increase the risk of fracture.

Regardless of prescription medication use, it is important for all patients with decreased bone density to consume adequate amounts of calcium (at least 1200 mg/day) and Vitamin D (400-800 IU/day), regularly perform weight-bearing exercise, and avoid smoking and excessive alcohol intake.

Response prepared by Sherri Steinkirchner, Pharm D. Candidate, Ohio Northern University

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