The beneficial effects of the osteoporosis drug alendronate (Fosamax) last for at least a decade with no untoward side effects, according to one of the longest controlled trials ever performed on the drug. Once stopped, the drug’s benefits started dissipating, but only gradually. Experts say the research should allay fears that once stopped, the drug’s effects would wear off quickly, leading to bone brittleness and other symptoms of osteoporosis. The results appear in the March 18 issue of the New England Journal of Medicine. Because osteoporosis is a chronic condition that requires long term treatment, it is helpful to have long term data, explains lead author Dr Henry Bone, director of the Michigan Bone and Mineral Clinic and head of endocrinology at St John Hospital and Medical Center, both in Detroit. According to an accompanying report in the journal, osteoporosis is fast becoming an epidemic with the ageing of the world’s population and increasingly westernised lifestyles. A 50-year-old woman in the US now has a 40% lifetime risk of suffering an osteoporotic fracture. Fosamax works by preventing bone resorption, which occurs when bone material is removed from the body naturally without being replaced quickly enough. (Health Scout)
The cure was worse than the complaint for 41-year-old Alan Weaver of Christchurch. Eighteen months after starting prednisone to treat his rheumatoid arthritis his bones had thinned so severely that his back broke during a muscle seizure.
Thinning bones (osteoporosis) is a known side effect of prednisone, but Alan feels he should have been monitored more closely to detect the unusually rapid changes in his bone strength.
Initially he was delighted with the prednisone treatment. As in so many cases, his onset of rheumatoid arthritis four years ago was extremely fast and painful, and the prednisone worked “fantastically well” – at the beginning.
But it wasn’t long before the low dose he had started on was failing to give any relief and he was put on prednisone 20mg for four to five days at a time. When that wasn’t having the desired effect the dose was increased again, with two month breaks between courses. Finally, Alan needed even more prednisone to control his rheumatoid arthritis, and he started taking 80mg for 10 days each month.
Then after 18 months of prednisone treatment he woke up at 3am one morning in terrible pain.
“I could hardly move. My doctor told me to come in after the weekend if it hadn’t improved. When he saw me he sent me straight to the hospital for an X-ray. This showed that a vertebra had crumbled away and I had a compression fracture in my back.”They told me I had the bones of an 80-year-old.
“Two weeks later a further x-ray revealed more crumbling of the vertebrae. Alan’s back was collapsing under its own weight.
“I was really surprised,” he said. “Over the years I’d fallen off roofs and motorbikes and never broken a bone.
“Although his doctors had given him written information which mentioned the possible side effect of bone thinning with prednisone, Alan feels he should have been offered scans to monitor his bone density, and given calcium supplements and other bone building medicines to protect against bone thinning.
He is now taking the bisphosphonate drug Fosamax (alendronate sodium) which helps stop bone loss and rebuilds bone, plus calcium and Vitamin D. He is due for a bone scan in another two to three months, to check his progress. His medicine regime also includes methotrexate, Arava, Losec, folic acid and drugs for his epilepsy. “Altogether I take 116 pills a week. I feel like I’m rattling with them,” said Alan.
Alan Weaver accepts that his days as the manager of a demolition recycling yard are over, but he still intends to remain an active sailor. His yacht is currently being fitted with self tailing winches which require only one hand to operate, a furler to automatically roll up the front sail and an automatic pilot.
Then he intends setting off from Lyttelton for the Marlborough Sounds, and sailing across to Wellington in time to help with the Arthritis New Zealand annual appeal in September. Alan is a great supporter of Arthritis New Zealand, and his boat sports the name of the organisation in its signature orange.
Arthritis seems to run in the Weaver family. Alan’s grandfather developed it late in life, and his 75-year-old father is now almost bedridden with arthritis. “I keep thinking of my father and seeing my own future,” says Alan. “I’m trying to get in as much activity as a can, now while I still can.”