Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group Femur Fractures & Bisphosphonate Use

http://www.orthosupersite.com/view.aspx?rid=77874

Atypical Diaphyseal Femur Fractures in Patients With Prolonged Administration of Bisphosphonate Medication for Osteoporosis
by Joel A. Horning, MD; John Czajka, MD; Richard L. Uhl, MD

(snip...) "Recently, reports of subtrochanteric and diaphyseal femur fractures associated with long-term bisphosphonate use have been published. These fractures are atypical in that they are associated with minimal trauma and are transverse or short oblique in nature. Their occurrence may be associated with concomitant use of other antiresorptive agents, corticosteroids, and proton-pump inhibitors.8-10 Although complete fractures are rare,2 patients may report thigh pain and have characteristic radiographic changes that can be identified prior to fracture (Figure 1). Recognizing these prodromal symptoms and stopping the medication may prevent these fractures." (more...)

Mechanism of Action

Bisphosphonate drugs act to inhibit bone resorption. Bisphosphonates have a pyrophosphate-like backbone that binds to calcium in bone. Because there is no enzyme that can breakdown this backbone, these medications have a half-life >10 years.

Bisphosphonates are subclassified into nonnitrogen-containing and nitrogen-containing based on their side chain composition. Nonnitrogen-containing bisphosphonates are metabolized into adenosine triphosphate analogues absorbed by osteoclasts. These analogues build up within the osteoclasts and become cytotoxic, leading to decreased cell function and the induction of apoptosis. Nitrogen-containing compounds act by inhibiting farnesyl diphosphate synthetase in the mevalonate pathway, which is important maintenance of the cell membrane. This inhibition causes disruption of the ruffled border and also leads to apoptosis.11-13

Through their action on the osteoclast, bisphosphonates decrease bone resorption and in turn increase bone mineral density, resulting in increased bone strength and decreased risk of fracture during the first 5 years of administration.14 However, while the ultimate strength of the bone improves, its toughness decreases by as much as 20% due to the accumulation of microdamage and lack of effective remodeling within the bone.15-17 The decrease in toughness may lead to failure in areas with high tensile forces, such as the subtrochanteric and diaphyseal regions of the femur." (more...)

Conclusion

(snip...) "When presented with a patient reporting thigh pain while on bisphosphonate therapy, one must be vigilant in evaluating radiographs to prevent pathologic fracture. Although drug holidays have been recommended, they have not been proven to prevent these fractures. Surgical intervention with prophylactic intermedullary nailing may be undertaken for incomplete insufficiency fractures due to their poor healing potential."

Letters:-[/b]

http://www.orthosupersite.com/view.aspx?rid=77870

[b]Atraumatic Bilateral Femur Fracture in Long-term Bisphosphonate Use

----------------------##

Simple way out of this one, Strontium Citrate. Strontium Citrate does not stop bone turnover and bone resorbition like the Bis drugs do, and, Strontium Citrate strengthens bone. It's a no brainer.

if i prevent a bone fracture due to bisphosphonates, i will have you to thank!

Ah, but a bone fracture might be due to osteoporosis, soooooooooooooooooo take good ole Strontium Citrate - you know it makes sense 'smile'.

Am pretty sure that ere too long those Bis drugs will be discontinued. They are not only dangerous but, they don't even work! The evidence against their use continues to pile up - but of course they have been a great milch cow for pharma. Fortunately, the FDA is 'beginning' to take a somewhat jaundiced view of em.

ok, let me rephrase then:


if i prevent a bone fracture, i will have you to thank, not only for warning me about the bisphosphonates, but also getting me to start taking strontium!


yes, been upping my calcium, taking it as citracal (along with the total cereal and dairy foods (stoneyfield yogurt, an ounce of cheese each day), and taking my D, and taking my strontium at night.

the citracal is thanks to jewelz! finally a calcium that doesn't bother my stomach. i had thought it was the calcium all those years, but think it was the carbonate part of the calcium carbonate that was the problem.

and the strontium: have been cautious due to warning i read about how it could affect my stomach, but so far, no problems!

hope next bone scan in a year and a half will show either stabilization or improvement, then the docs will allow me to continue to manage it as i have been.

so long as i can get the D levels up....they dropped during my last undigested food episode even on the prescription D.

as for magnesium, when i try to take the pills, i get loose bowels. but calculated that i'm getting a lot of magnesium from all the good fruits and veggies i'm eating.

hope i'm doing everything right now, we'll see, at least there's an easy test for it!

yep, gotta take good care of dem bones!

Yea - dem dere bones will be good until ya finished with em gal. Terrif protocol to follow, way to go. BTW - DEXA will havew to be calibrated for Strontium as opposed to standard as it won't read you correctly otherwise...big bore. Though, there IS another test, but forget the details - posted on it some 3/4 rys ago here. (Flip, time flies). A real easy test. Hmmmmmm. Will have to google it up. Will need to follow it myself as well. OK. Job for today. Thanks Sue. (Just realised, and Too funny, my fave neck pillow is called a full 'bone'...hahaha)

ah yes, thanks for that reminder about the dexa scan, hope they know how to compensate for that, will do some reading, but also whatever you find as well!

I just googled it up. Protelos have a patient help phone line - see forum input here http://www.nos.org.uk/forum/Topic410-3-1.aspx Protelos is Strontium Ranelate (that is the chemical synthetised version of the pure form of Strontium Citrate) and they can give the information. Still googling away as there are other sites to explore, including one that seems to suggest that one stops taking SC 30 days before the DEXA scan, but got to explore further.

More info here:-

http://www.osteopenia3.com/Strontium-dexa-scan.html