bisphosphonates Update by FDA

What scares me is that we don't really have an FDA like we used to (we have one in name only). You don't know what is true and what isn't. I have been told one should rely on sources from medical sources in other countries. I would probably believe sources like Mayo Clinic or Cleveland Clinic. The AMA is still supposed to be a reliable source. I don't really trust information coming from US sources from the last couple of years, certainly not FDA or CDC. Just my opinion.

@gracierose
Remember to take Vitamin K if you take Calcium.
This vitamin helps to ensure that the Calcium is directed to the bones, and does not end up in the bloodstream. Just look it up. There is lots of information available.

@lynnc75
Thanks to all for the discussion about AFF and bisphosphonates--I just started taking it (am very near osteoporosis) and am rethinking that strategy.

And seeking information (!) because it seems impossible to absorb enough Calcium to build up my bones:

1/ I'd love to take vit K2 because I'm a vegetarian and don't eat meat.
But I'm on Eliquis (blood thinner) and Flecainide for AFib.
All articles about Vits K1 and K2 caution against combining with blood thinners, so I've reached out to my cardiologist.

2/ PROTEIN helps with bone health but my protein sources (canned beans and chickpeas) are high in phytates and oxalates, which bind to the calcium supplement or calcium-rich foods, and cancel out the calcium.

3/ The whole wheat pastas and homemade whole wheat breads I've lived on for decades also bind to calcium in the food sources I've relied on for bone strength.

4/ Vit D3 increases absorption and I take a supplement but I have had skin cancers so have to cover up from the sun and limit skin exposure.

There's SO much conflicting info and/or a lack of simple-to-access info, so I appreciate your thoughtful posts.

@daisy17
Thank you! I wonder why we aren’t just told to greatly increase calcium intake and just forget the whole alendronate/meds thing!!! I am definitely feeling joint pain and upset stomach, as well as EXTREME anxiety in my third month of taking this once a week dose of alendronate. But with having had breast cancer with chemo and mastectomy with implants 10 years ago, I get kind of crazy and don’t know where to look for answers and relief…

@suehall We share the quandary of being on eliquis and wanting to add K2 for bone health. I'm not considering K2 in the MK-7 form because some people have experienced heart palpitations but I am interested in the MK-4 form used in Japan to treat osteoporosis. I would probably start on a lower dose rather than the higher dosage prescribed in Japan.

I've asked one of my cardiologists and an electrophysiologist who did my heart ablation about the safety of taking MK-4 and both had no opinion against it. I doubt either one of them ever even heard of MK-4. I just asked another of my cardiologists who specializes in cancer (I have breast cancer) and she also was uninformed about it but has asked me to send her my question about MK-4 and she will run it by her pharmacy team.

In other words, I think we're on our own regarding the use of vitamin K2 when taking Eliquis. Will post what, if anything I hear, from the pharmacist. Meanwhile, I encourage you to share what your cardiologist has to say about eliquis and K2. Here's to your good health!

@gracierose Extra high doses of calcium aren't recommended, I think because your body can only absorb about 500mg at a time. And too much calcium can also be bad for you. Be sure to take Vitamin K, which helps direct the calcium to your bones.

I refused Fosamax due to the side effects and articles I read that said it offers minimal protection against fractures. If you are interested in that, I could provide links to some articles.

When I declined Fosamax, my endocrinologist said he could prescribe it at 1/2 the normal dose, which would be 35mg a week. He said studies showed that dosage was effective. If you're having uncomfortable side effects, you could ask your Dr about that option.

@daisy17
Thanks for this clarification.
Can you share the articles about Fosamax and its effectiveness/effects?

@suehall There are many articles about studies done on this, here are a few:
https://www.amjmed.com/article/S0002-9343(24)00101-3/pdf
The last paragraph offers a summary of findings: "for patients with osteoporosis based on bone density alone, treatment benefits are less certain. Hip fracture risk reduction is modest and not supported in patients without a history of fracture. Reductions in vertebral fractures are substantial regardless of baseline risk, but whether these reductions correspond to less chronic pain and disability is unclear. Clinical evidence is weaker for newer agents. Future guidelines and reviews on osteoporosis treatment should clearly distinguish between primary and secondary prevention of fractures to best inform clinical decision-making. Despite guideline recommendations and calls for more screening and treatment, there are legitimate reasons for some clinicians and patients to opt out."

Another article by Consumer Reports: https://www.consumerreports.org/cro/2012/04/popular-osteoporosis-drugs-come-with-mounting-concerns/index.htm
From this article: "Bottom line. Bisphosphonates offer only modest benefits in building bone and preventing fractures, and that should be considered along with the risks."
https://www.futurity.org/bisphosphonates-atypical-femoral-fracture-1509822-2/
The above article explains that these drugs slow the shedding of old bone, and also slow the rebuilding of newer bone, leaving bone that can be more brittle than newer bone. That is why some studies show that the bones may appear more dense on a DEXA scan, but offer minimal benefits of fracture prevention.
From the article: "bisphosphonates’ main function: slowing the resorption (shedding) of old bone, which is typically followed by remodeling, the growth of new bone. In healthy adults, cortical bone is constantly being resurfaced, such that the entire adult skeleton is overhauled every 10 years or so.
But that resurfacing process begins with resorption, and if resorption is slowed by bisphosphonates, the remodeling process is also affected. The result: The existing bone ages and gets brittle over time. “It’s kind of a double-edged sword. It’s extremely good to prevent bone loss, but the drugs will also slow this natural process, which allows turnover.”
The other unforeseen side effect to long-term bisphosphonate use involves crack-deflection—the resurfaced bone’s ability to stop a microscopic crack from propagating, which can lead to a break. New layers of bone can act as a “firewall” of sorts, stopping a crack from spreading, but mineralized, older bone loses that function.”

@daisy17
Thank you for taking the time to share this information. Super helpful.

@suehall Just fyi, my well-respected endocrinologist does not agree with me and thinks the benefits of Fosamax outweigh the risks, but he respects my choice.