Are biphosphonates safe or do they cause osteonecrosis?

Question

My oncologist prescribed Actonel to prevent osteoporosis. As part of my breast cancer treatment, they have chemically induced menopause. Now, my Infectious Disease doctor/husband, has read that these medications can cause osteonecrosis. Since I am just 50, I had planned on taking the Actonel on a long term basis. Is this safe? Before talking with my oncologist, I want to gather information. Please advise. Thanks.

Answer 1

There have been some cases of osteonecrosis of the jaw in patients, but the numbers are small. Everything is a risk, there are no free lunches. Actonel and Fosamax both increase bone mass, and studies have shown that the bone mass is as good as if it were never not there. Fractures of the hand, spine etc., (Dowager's Hump) are less in patients taking these medications. Caucasion women, and Asians are particularly prone to osteoporosis, since they are naturally lighter boned than say black women---i.e. they begin menapause with less bone mass. You probably now are producing no estrogen, therefore are open to bone resorption at a faster level than if you were on HRT. Estrogen keeps a woman "younger" than she would otherwise be -- estrogen keeps collegen in place, slows the process of wrinkles, allows vaginal tissues to remain thick and strong, reduced constipation by keeping the lower bowel fit, keeps mental accuity, and on and on and on. But estrogen dependent cancers tend to kill, so women with estrogen dependent cancers generally have a hysterectomy with ovary removal. The interesting thing about Actonel and Fosamax is that even if you acquire osteonecrosis of the jaw, even if you stop, the drug remains in your system for years.....that's why it is no big deal to miss a week once in a while, or to not take the pill every day of the same week. In your place, the threat of osteoporosis is a greater one than osteonecrosis of the jaw. I take Fosamax, and plan to do so for the rest of my life....