Dr Bone is connected to the bone drug

Proof positive that long-term alendronate use is safe and effective for women with OA. Boning up on minerals

By Raymond Reese

Alendronate � a member of the bisphosphonate family � is a drug that has some serious rituals attached to it. Patients are advised to take it first thing in the morning, avoid combining it with any food, coffee or orange juice, and to remain upright for 30 minutes after taking the drug. Apparently, there is a method to the madness as the drug refuses to be absorbed unless taken on an empty stomach. And those who don't comply and lie down right after taking it will suffer a burned esophagus. So, why put up with this finicky drug? Because it's been touted as a champion in the fight against osteoporosis because it blocks the normal bone reabsorbing activity of osteoclasts. But the effectiveness and safety of long-term alendronate use has been a mystery. Now, at last, there's proof.

Dr Henry Bone of the Michigan Bone and Mineral Clinic in Detroit and his colleagues conducted a decade-long, double blind study to evaluate the extended use of alendronate. At the end of the trial, the results spelled good news for patients � alendronate is a safe long-term hedge against osteoporosis. "Continuous treatment with 10mg of alendronate daily for 10 years was associated with sustained therapeutic effect on bone density and remodelling, with no indication that the antifracture efficacy of the drug was diminished," according to the authors of the paper published in the March 18 issue of the New England Journal of Medicine (NEJM).

Two hundred and forty seven postmenopausal women with osteoporosis took part in the study. Those in the treatment group were given three daily doses of 5 or 10mg of alendronate. Control subjects on the placebo got a two-year daily blast of 20mg of alendronate in the fourth and fifth years and were then switched back to the placebo for the remaining five years.

Of the women who completed the 10-year study, those treated with 10mg of alendronate every day packed on minerals in the lumbar area of the spine, trochanter, femoral region of the neck and femur. The 5mg dose was also effective, but the results were not as dramatic. Women who didn't receive the decade-long course of the drug were not so lucky � they suffered a gradual whittling away of bone density.

Alendronate's good news doesn't mean that extended treatment for osteoporosis should be the norm, cautioned the authors. "Because each therapeutic agent may have unique characteristics, our observations shouldn't be assumed to apply to other treatments for osteoporosis."

As well, "the optimal duration of [alendronate] treatment hasn't been established," said Dr Gordon Strewler in an accompanying NEJM editorial. "Better data regarding the relative risk of fracture associated with continued treatment as compared with the discontinuation of treatment will be required for good clinical decision making."

Still, the latest news brings hope to the estimated 1.4 million Canadians with osteoporosis. Aside from the high cost in human suffering, the disease sucks some $1.3 billion out of the healthcare system annually.