Rare Fractures Linked To Drugs For Weak Bones Dr. Jennifer Schneider was one of the first women to suffer from an unusual fracture she believes was caused by osteoporosis drugs she'd taken for years. A new study confirms that women who've been on bisphosphonates more than five years have nearly three times higher risk of the unusual fractures.

Rare Fractures Linked To Drugs For Weak Bones

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On a Monday morning, it's MORNING EDITION from NPR News. I'm Steve Inskeep.

Today in "Your Health," we'll hear about an experimental device that translates movements of the face into computer-generated speech. But first, we're going to hear about a problem that affects millions of older women with osteoporosis, a common disease that makes bones brittle.

For 15 years now, women have been able to take drugs that fight osteoporosis and prevent fractures. But in the last couple of years, specialists have begun to worry that long-term use of these same medications may actually cause an unusual kind of fracture. Here's NPR's Richard Knox.

RICHARD KNOX: Jennifer Schneider was one of the first women to suffer one of these nasty, unusual fractures - or at least, her case was one of the first reported in a medical journal.

Dr. JENNIFER SCHNEIDER: I could hear it and I could feel it. I knew it was broken - instantly.

KNOX: It was her right leg. It happened when she was riding a subway train in New York City.

Dr. SCHNEIDER: As the train approached a station, it jolted. And I shifted my weight from one leg to the other, and I felt my leg cracking.

KNOX: Schneider's thigh-bone had snapped in two - just at the part that's usually the strongest.

Dr. SCHNEIDER: I could not understand how this possibly could have happened from standing on a train.

KNOX: Surgeons installed a metal rod to hold her shattered thighbone together. But after many months, the bone just wasn't healing. Now, Schneider is a doctor herself. And one of the things she started suspecting was an osteoporosis drug she'd been on for seven years. It's called Fosamax. It works by slowing down bone metabolism - the building of new bone that doctors call turnover.

Dr. SCHNEIDER: Since you need bone turnover in order to heal a fractured bone, continuing to take this drug might, in fact, inhibit bone healing.

KNOX: So Schneider decided to stop taking Fosamax. And eventually, the fracture healed. But after two years off the drug, tests showed her bones were thinning. And doctors urged Schneider to go back on Fosamax.

Dr. SCHNEIDER: I did go back on it. And within a year, I had a stress fracture of a metatarsal, which is a bone in the foot. And so I stopped the drug and never went back to it.

KNOX: Schneider decided to write herself up as a case report in the journal Geriatrics. Her report challenged the idea that women should keep taking these drugs for the rest of their lives. When Schneider wrote that five years ago, many doctors scoffed at her claim that the drug was responsible.

But last week, the Journal of the American Medical Association published a large study done in Canada that suggests long-term use of these osteoporosis drugs does raise the risk of unusual thighbone fractures. In fact, women who'd been on the drugs more than five years had nearly three times higher risk. Dr. Gillian Hawker, of St. Michael's Hospital in Toronto, worked on the study.

Dr. GILLIAN HAWKER (St. Michael's Hospital, Toronto): Although the number of fractures of these unusual fractures was pretty small - they're pretty rare - it nonetheless did show a relationship with longer-term use.

KNOX: Pretty rare, but since tens of millions of women are on the drugs, the study suggests that thousands of them may suffer these devastating fractures every year. But here's the dilemma: Many women need these drugs because they really do work to prevent regular hip fractures caused by osteoporosis.

Dr. HAWKER: Hip fracture is a horrible, horrible event, period. Very, very devastating, and often an end-of-life event.

KNOX: So the drugs are necessary. But Hawker says not all older women should be treated.

Dr. HAWKER: You know, I'm in my early 50s, and my mother and all my friends' mothers have horrible osteoporosis, multiple fractures. And that is really preventable in 2011. That's wonderful. But in the heyday of the early days, when we all got excited about these medications, I think a lot of people who really probably didn't need to be on them, went on them.

KNOX: Schneider, the doctor who broke her leg on the subway, says she's one of those women. When the drugs were first approved, many doctors thought women would be better off if they started on an osteoporosis drug before developing serious bone loss. Schneider began taking Fosamax on the basis of a bone density scan that showed some age-related thinning, but not enough to be called osteoporosis. Now, she thinks that was a mistake.

Dr. SCHNEIDER: We should not be so ready to put patients on these drugs as soon as their bone density starts dropping.

KNOX: A growing number of experts agree. Dr. Cliff Rosen, at Maine Medical Center in Portland, says now specialists are worried about the risk of unusual thighbone fractures.

Dr. CLIFF ROSEN (Maine Medical Center, Portland): These kind of fractures -which, you know, are uncommon but we've all seen them - now raises this specter that gee, we really need to rethink who we treat, when we treat, and how long we treat.

KNOX: There's evidence that five years on these drugs may be good enough to prevent regular osteoporosis factures. And taking a break at that point may be a good idea. Rosen says the take-home message is: Don't start one of these drugs too early. Wait until you actually have osteoporosis. And once you start, don't stay on it too long.

Richard Knox, NPR News.

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