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BisphosphonatesFrom: Joanne Bulley, MD (islesannie@yahoo.com)Fri Apr 28 07:35:51 2006
When you are treating woment with a bisphosphonate do you 1) leave her on it forever 2) treat for 1-5 years and stop and observe 3) something else. How long do you think she should remain on the bisphosphonates? I have a patient whose mother had horrible osteoporosis. Mom was put on Fosamax (After many fractures) and stayed on treatment until at end of life from other isseus. When they stopped the fosamax, the daughter said it was as if the bones started shanging shape - getting protuberances that could be seen and felt by the caregivers (primarily this daughter). Have any of you seen that sort of thing when coming off Fosamax after 10-15 years use? I have asked the question at a number of conferences regarding IF the bisphosphonate permanently blocks the osteoclasts - what happens IF the woman had a standard fracture after being on the drug for 5-10-20 years? Can the bone still remodel and if so does it remodel properly? I have never gotten any sort of straight answer - usually some skirting the issue and "we don't really know" This patient of mine has now been on Fosamax since 2001. Spinal BMD down to T score of -3.1 at its nadir and femur at -2.2. Both have come up some and staibilized at spine -2.5, femur -2.0 on treatment. I have explained the bone microarchitecture and the decrease fracture risk even if the numbers don't head back toward T score of 0. She has had a couple of significant falls without fracure. Anyhow - I have seen docs treat for 2-3 years then give a break - but what are Listers doing? As others have said - this is where I get valuable in-the-trenches information!
-- Joanne Bulley, MD Keene, NH, USA
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