What is Bisphosphonate Medication?

Bisphosphonate medication is a class of prescription medications that prevents the loss of bone mass over time by preventing the action of a certain type of cell called osteoclasts. Medical doctors use bisphosphonates to reduce the risk of fracture in patients with bone diseases that weaken bone structure, such as osteoporosis and the bone metastases of cancer.

Bone Health

Interestingly, although we view our bones as the stable foundational structure of our body that stops growing when we do, it is actually still a living tissue. This tissue is constantly being "turned over", with old, potentially damaged bone being replaced by new bone to ensure continued structural strength. Old bone is reabsorbed by cells called "osteoclasts", while new bone is laid down by cells called "osteoblasts". These two processes are in delicate balance and should occur at approximately equal rates to ensure that we keep our full bone mass and density over time. Osteoporosis is a loss of bone density that can be caused by too much bone being broken down without enough being built in its place.

Osteoclasts

Bones contain and store many important nutrients and minerals that our body requires to maintain health and proper functioning. Osteoclasts help us access these nutrients by breaking down damaged and fractured bone. They’re destructive cells that are actually good for us. So good for us, in fact, that they are necessary for our survival. When bone is broken down, minerals and nutrients are released into the bloodstream, and osteoblasts are free to repair and build new bone, which improves bone density.

What is Apoptosis?

Bisphosphonate medications inhibit the function of osteoclasts and actually promote this cell type to commit cell suicide, a function known in the cellular world as "apoptosis". This can be useful in some patients who are experiencing excessive osteoclast activity that is causing a severe reduction in bone density. Unfortunately, this also causes a failure of bone to turn over and prevents our bodies from being able to repair the small microfractures and damage that occurs from everyday use. This is a condition referred to as "adynamic bone disease". Over time, this can result in the accumulation of damaged bone, which eventually leads to an increased susceptibility to fracture. Our concern with the progression of osteoporosis is only because it increases the risk of bone fractures. Through a dynamic bone disease, bisphosphonate treatment can eventually cause the very condition it is trying to prevent. The overactivity of osteoclasts is rare, and usually their apparent excess is actually due to insufficient new bone being made by osteoblasts. This can often be from a lack of sufficient building blocks for new bone growth, such as protein, calcium, and vitamin D, or insufficient weight-bearing exercise for stimulating new growth.

Length of Bisphosphonate Medication Treatment

Although initially it would seem to be OK to use bisphosphonates in the short term, just to help people with acute problems like bone metastasis, it turns out these drugs hang around in our bodies. Research on pharmacokinetics has shown that bisphosphonates can remain in the bone for many years. Long-term bisphosphonate use (longer than 5 years) has been associated with adynamic bone disease and bone death (necrosis) in otherwise healthy individuals. If necessary, bisphosphonate treatment should be used for as little time as possible, and use should not exceed 5 years, at which point the detriments outweigh the benefits.

Side Effects of Bisphosphonate Medication

Oral bisphosphonates can cause a number of different side effects. The most common are: abdominal pain, bone pain, nausea, constipation, diarrhea, acid reflux, and headache. Another important side effect is atrial fibrillation, a disordered fluttering of the upper chambers of the heart. More recent research has found that women taking bisphosphonates have a higher incidence of fractures of the large leg bone called the femur. This is likely due to the lack of remodeling, as described above. More recent research has also found that prolonged bisphosphonate use is associated with a higher risk of esophageal cancer.

Safety Notes

Although bisphosphonates were originally seen as a revolutionary new way to treat osteoporosis, it is becoming clear that for the average person, the risks outweigh the benefits. This is particularly true for treatment proceeding for longer than 5 years. If you are currently using one of these medications or are considering going on one, you may want to discuss other options with your doctor. For less severe cases, it may be preferable to try some natural methods to increase your bone density first. One of the best things you can do is increase the amount of weight-bearing exercise that you do every day, such as walking, running, jumping, and lifting weights. Eating enough protein and getting enough of the bone-building minerals will also help you to improve your bone health. There are a number of different influences on bone density, which gives us a lot of different ways to approach treatment. Don't be afraid to speak with your healthcare practitioner about your other options, whether they be pharmaceutical or natural alternatives.