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Much Ado About...Osteoporosis

Believe it or not, I have been all atwitter about the FDA's approval of the new non-biphosphonate osteoporosis drug, Forteo. My thinking was that anything would be better than the current favorite, Fosamax. Fosamax is a biphosphonate drug which is basically a purtied up cousin to the cleanser you clean your bathtub with. Your ring around the tub? It's dissolved by a biphosphonate. Now, imagine swallowing Comet in a capsule and you have some idea of Fosamax and why it can have such horrible side effects - like esophageal inflammation and ulceration, renal failure, ocular damage,hepatitis and skin damage. Who funded the study on why most women over 60 should be on Fosamax? Why, Merck, the huge American conglomerate and manufacturer of Fosamax.

Another biophosphenate, Zometa, was approved for use in February. This one is winning the popularity contest so far because it needs to be given only once or twice a year - the old vaccination mentality at work here. Who funded the study on the efficacy of Zometa? Why, Novatis, the huge Swiss conglomerate and manufacturer of Zometa. Let me tell you a bit about bone. Good bone density requires a delicate balance - between bone removal by scavenger cells called osteoclasts and bone rebuilding by our heros, the osteoblasts. Here's the bad news about the biphosphonates: They poison the osteoclasts, the scavenger cells responsible for removing the old bone. All that old bone is left there. Bad bone. Fragile bone. Easy to break bone. Either the osteoblasts stop depositing new bone or they deposit it right over the old, bad bone. Nasty. All studies show that although bone appears radiographically denser when you take Fosamax, this does not necessarily translate to stronger. This may be hard to grasp, but low density does not equal fragile, breakable bones. Bone mineral density relates to the quantity, not the quality of the bone. Bone density tells you nothing about the strength, micro-architecture, size or shape of bone, all of which are factors contributing to fragility. But, nobody wants to tell you this. You have a bone density test and someone tells you that you have osteopenia. Well, that scares the wee out of you and you race to the nearest drugstore to fill your prescription for the biphosphonate du jour. To the tune of $1.76 BILLION dollars in 2001. Osteoporosis is very big business and one of the most commercially profitable diseases ever (vying for first place with cancer) because it targets the well and the worried. (The Osteoporosis Epidemic - Well Women and the Marketing of Fear by Gill Sanson, 2001). But, for whatever nefarious reason, (radiographic) low bone density remains the default definition of osteoporosis even though the vast majority of the population never has a fracture. "Women should not worry about osteoporosis. . . The osteoporosis that causes pain and disability is a very rare disease." says Dr. Bruce Ettinger, Endocrinologist at the University of California. Furthermore, claims that Fosamax and other biphophonates significantly reduces fractures is simply not true (The Dr. John Lee, M.D. Newletter, 6/02) and concerns are now being raised that using the drug for more than 5 years may produce an older skeleton with more crystallized bone which will fracture more easily. Back to the beginning: What about Forteo - the new kid on the block that was approved for use on November 26, 2002? Of course we can only imagine how thrilled Eli Lilly is to be feasting on the cash cow, but here comes the not so good news: 1) It's injectible only. 2)Rats got lots of bone cancer from Forteo. 3) And some women also reported nausea, dizziness and leg cramps. So, for me so far, it's a big thumbs down. More next time on osteoporosis and how we can keep our bones nice and strong. Hint: Not necessarily by drinking milk.


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