Balance risks, benefits of drug for osteoporosis

Do you take your bones for granted? Most of us do, unless we break one. If that happens, we often have to cope with a great deal of pain and inconvenience. If we break a leg or a hip, it becomes far worse, especially for older people.

That’s why there was so much excitement within the orthopedic community a few weeks ago. A study from New Zealand reported positive results from an old medication for osteoporosis (New England Journal of Medicine, online, Oct. 1, 2018).

Researchers recruited 2,000 older women who had early signs of bone weakness (osteopenia). Half received placebo injections every 18 months. The other half received an infusion of zoledronate (Reclast) every 18 months. The study lasted six years.

The researchers reported 190 women in the placebo group experienced fragility fractures compared with 122 women receiving zoledronate. That is roughly a 30 percent reduction in fracture risk.

The authors noted that 15 women would need to be treated to prevent one broken bone. That is considered a very good response rate. Some bone specialists have hailed this study as a game changer. Others call it a breakthrough.

The New Zealand trial did not report any serious side effects. But zoledronate can cause adverse reactions. The official prescribing information lists arthritis pain, muscle pain and back pain as relatively common complaints. Other symptoms may include headache, dizziness, high blood pressure, indigestion, nausea and abdominal pain.

There also is an “acute phase reaction” that can occur within the first three days of getting an infusion. Symptoms may include fever, chills, pain and a flu-like illness.

One reader of this column describes her reaction this way:

“I had a Reclast IV infusion one week ago. One day after the injection I got a fever, chills, flu-like symptoms, nausea and felt terrible! I went back to the doctor’s office and they said it will get better. Yes, after one week, the chills, fever, nausea and flu symptoms went away!

“Now I have terrible joint pains. My hands hurt so bad I can barely pick up a cup of coffee. My hips, back, legs, ankles and arms hurt terribly. I hope this also goes away, because it is limiting what I can do. I wish I had asked or been told what the side effects of this drug were before I took it!”

Although the New Zealand researchers report no serious side effects, other readers have complained of long-lasting pain. One woman shared this story:

“After a bone scan my doctor prescribed a Reclast infusion. I was in good health. A couple of days after getting the infusion I could not get out of bed. Within a couple of weeks I began having bad joint and bone aches that I had never had before.

“It has been two years now, and I have severe hip pain and joint aches. I never had such symptoms before Reclast. I also have neuropathy in my legs and arms. This drug greatly altered my life.”

It is hard to weigh the clear benefits of zoledronate to prevent fractures against the possible risks of joint and muscle pain. Health professionals must provide complete information on this drug so that women at risk of osteoporosis can make an informed decision.

Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. In their column, the Graedons answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website:

2018 King Features Syndicate

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