Oral bisphosphonate osteoporosis drugs, which include such Actonel, Boniva, and Fosamax, could be associated with an approximately twofold increased risk of esophageal cancer.
A new study showed that long-term users of the drugs had nearly double the risk for the rare but deadly cancer.
Concerns about a link between bisphosphonates and esophageal cancer first reached the public a year and a half ago, when an FDA report cited 23 cases of the cancer in Fosamax users in the U.S., and another 31 cases in Europe and Japan.
WebMD reports:
"The ... analysis included close to 3,000 patients with cancer of the esophagus, 2,000 patients with stomach cancer, and 10,600 patients with colorectal cancer diagnosed between 1995 and 2005. Each cancer case was compared with five people without cancer matched for age and sex."
Sources:
WebMD September 2, 2010
BMJ September 1, 2010; 341:c4444.
Dr. Mercola's Comments:
Osteoporosis is a very common problem, affecting one in three women and one in five men over the age of 50.
It’s characterized by porous and fragile bones, increasing your risk of fractures, most often your hips, spine and wrists. Interestingly, nearly 75 percent of all hip fractures occur in women, and hip fractures, worldwide, rose 25 percent in just ten years, between 1990 and 2000.
All in all, osteoporosis is a major health risk for nearly 30 million Americans, in large part because many are clueless about how to prevent it.
As a result, osteoporosis has become yet another boon for the pharmaceutical industry. According to a 2010-2025 Osteoporosis World Market Report, the condition generated pharmaceutical revenues of over $12 billion worldwide in 2009.
Unfortunately, osteoporosis drugs are now also increasingly prescribed to women with osteopenia, a natural thinning of the bones as you get older, even though no conclusive benefit has been found for this condition.
The Conventional Approach – A Dangerous First Line Defense
There are a variety of drugs on the market to combat bone loss, but the first line of therapy typically includes oral bisphosphonate drugs, such as:
Fosamax
Didronel
Boniva
Actonel
Reclast
In June of this year the US FDA also approved a new type of injectable medication for the treatment of postmenopausal osteoporosis, as reported by CNN.
The drug, called Prolia, is a “biologic” medication, meaning it contains genetically engineered human proteins instead of synthetic chemicals.
The Los Angeles Times did a write-up on the drug, stating that:
“Prolia is a little bit different from the other osteoporosis drugs in that it's a complicated biological molecule — an antibody — that was specifically designed to bind to, and inactivate, a protein in the body involved in bone metabolism. That protein, RANKL, stimulates the breakdown of bone tissue during normal bone turnover. By inhibiting RANKL, Prolia suppresses bone breakdown and prevents bone loss.”
However, despite being entirely different from bisphosponates, some of the identical health problems have already surfaced with Prolia, such as jaw osteonecrosis (which I’ll discuss in a moment).
This is no surprise as it essentially works the same way as the bisphosphonates, as it prevents the normal dynamic building and breakdown of bone. It slows down the normal resorption so the bone becomes denser but not any stronger.
Other side effects of Prolia include “skin infections, some serious enough to require hospitalization, and other infections, such as in the ears, urinary tract and the heart. Back pain and pain in the muscles and bones have been reported, as have elevated cholesterol levels,” the LA Times reports.
Time will tell just how poor a choice this drug really is, but I can virtually guarantee you that, just like the bisphosphonates, it will not serve your long-term best interest.
Increased Cancer Risk Confirmed Among Bisphosphonates Users
According to this latest study published in the journal BMJ, long-term use of oral bisphosphonate drugs may double your risk of esophageal cancer – a rare but deadly cancer.
The authors concluded that:
“The risk of esophageal cancer increased with 10 or more prescriptions for oral bisphosphonates and with prescriptions over about a five year period.
In Europe and North America, the incidence of esophageal cancer at age 60-79 is typically 1 per 1000 population over five years, and this is estimated to increase to about 2 per 1000 with five years' use of oral bisphosphonates.”
This link came to light early last year, when a brief report in the New England Journal of Medicine revealed that the FDA had received 23 reports of esophageal cancer possibly linked to the drug.
The risk of contracting esophageal cancer from these drugs may still be low enough for many people to take the risk, but there are other, far more common side effects that can be just as devastating.
Side Effects of Osteoporosis Drugs can Be Far Worse than Brittle Bones…
Osteoporosis drugs have become increasingly well-known for their dangerous side effects, many of which could easily be worse than your original concern.
Acid reflux and related esophageal inflammation were a couple of the side effects that quickly became apparent when these drugs hit the market. This is why you’re instructed to take them with food and avoid lying down shortly after taking them.
But as I predicted over a decade ago, that’s just the beginning of the health nightmare these drugs can bring about.
Since their release, bisphosphonate drugs have also become associated with:
- Hypocalcemia (blood calcium levels are too low)
- Serious eye inflammation and possible blindness
- Severe musculoskeletal pain
- Stomach ulcers – particularly when taken together with anti-inflammatory drugs.
In one study, 8 percent of participants taking Fosamax and 12 percent of those receiving the anti-inflammatory Naprosyn developed stomach ulcers. But when the two drugs were taken in combination, the rate of stomach ulcers rose to a whopping 38 percent.
This is important, as many elderly, particularly women, are likely to suffer from both arthritis and osteoporosis, increasing the likelihood of bisphosphonates and anti-inflammatory drugs being taken at the same time. - Liver damage –Although the mechanism is still unknown, researchers believe drugs like Fosamax may inhibit the synthesis of cholesterol in your liver, which may alter liver function.
Regardless of the mechanism, if you’re taking Fosamax or related bisphosphonate drugs you need to beware of the possibility of liver dysfunction, and your doctor should monitor you properly for it. - Kidney failure (renal failure)
- Atrial fibrillation -- Women who have used Fosamax are nearly twice as likely to develop atrial fibrillation (quivering of your heart’s upper chambers), which is the most common kind of chronically irregular heartbeat
One study published in the Archives of Internal Medicine found that Fosamax was associated with an 86 percent higher risk of atrial fibrillation compared to those who had never used the drug.
Atrial fibrillation can cause palpitations, fainting, fatigue, or congestive heart failure. It can also lead to embolic strokes. - high bone (femur) fractures – Although you’ve only started hearing about this recently, the FDA asked Merck (the maker of Fosamax) to “add information about the report of femur fractures” to the medication’s package insert back in 2008, according to an ABC News report.
Sixteen months later they finally added it to the list of fine print side effects, but neither Merck nor the FDA properly informed doctors and patients of this newfound risk.
According to a recent report by a US panel of experts reviewing the evidence of increased risk of unusual femur fractures, 94 percent of patients who had experienced a femur break had been on bisphosphonate drugs. Most of them had taken the drugs longer than five years.
More than half of those who broke their thigh bones had reported groin or thigh pain for a period of weeks or months before fractures occurred.
In addition, “more than a quarter of patients who experienced atypical femur fractures in one leg experienced a fracture in the other leg as well,” Canadian CTV reports. - Osteonecrosis of your jaw bone (jaw bone death) -- This is a serious condition that can also cause disfiguration as the bone in your jaw dies and begins to decay. Symptoms include jaw pain, infection, and loosening of your teeth. However, some people experience no symptoms until they suddenly notice exposed bone. If you’ve had teeth extracted, or wear full dentures, you may also be at greater risk.Interestingly, an animal study published in the June issue of Journal of Bone and Mineral Research concluded that osteonecrosis of the jaw may involve the interaction between bisphosphonate drugs and vitamin D deficiency! As you will see below, optimizing your vitamin D levels is imperative for healthy bones, and this finding further strengthens that recommendation.
How Osteoporosis Drugs WEAKEN Rather than Strengthen Your Bones Over Time
It’s important to realize that, over time, these drugs will only worsen, not improve, your condition, because all you’re doing is fooling your body to produce a denser bone that is actually weaker – as evidenced by increasing rates of thigh bone fractures.
It’s ironic, to say the least, that these drugs, prescribed to treat brittle bones and prevent fractures, actually produce weaker bones and cause more unusual fractures that are exceedingly difficult to recuperate from.
Healthy bones maintain their strength from a continual process of bone breakdown and bone rebuilding. Osteoclasts are cells that break down bone, and osteoblasts are the cells that rebuild it.
Healthy bone undergoes a dynamic process of cyclical removal of unhealthy bone and replacement with new bone. This is how they remain strong.
In osteoporosis, the net rate of bone resorption (breakdown) exceeds the rate of bone formation, which results in a decrease in bone mass.
But it’s important to realize that Fosamax and similar drugs do NOT build any new bone. Rather they are metabolic poisons that kill off your osteoclasts, which halts the normal bone repair process since you now lack the cells that break bone down.
Your bones will indeed get denser. However, denser bones are NOT stronger, which is the part they don’t tell you. Eventually your bones become weaker and more prone to fracture.
In women who have been taking a bisphosphonate-type drug for five or more years, their bones have literally lost the ability to regenerate and this is why many may be faced with more brittle bones and fractures.
12 Steps to Optimal Bone Health
It’s tragic that drugs like Fosamax continue to be touted as the answer to osteoporosis, because nothing could be further from the truth.
These simple guidelines can help you maintain, or increase, your bone strength safely and naturally, without the use of drugs that might cause you even further harm:
Eat a healthful diet based on your body's unique nutritional type.
Eating high quality, organic, biodynamic, locally-grown food will naturally increase your bone density and decrease your risk of developing osteoporosis. If you find it difficult to eat the recommended amount of vegetables you need daily, you can try vegetable juicing.
One food in particular that is worth mentioning are onions, which are high in gamma-glutamyl peptides that have been shown to increase bone density.
Also remember that you need high quality protein like organic free-range eggs and grass-fed meats, because amino acids are part of your bone matrix. If you don’t consume enough of specific amino acids your body can’t form strong, dense bones.
Avoid processed foods. If you eat a diet full of processed foods, it will produce biochemical and metabolic conditions in your body that will decrease your bone density, so avoiding processed foods is a first step in the right direction.
Consume a healthy balance between omega-6 and omega-3 fats. Most everyone needs to take a high quality, animal-based omega 3 fat. I recommend krill oil, as I believe it’s a superior source of omega 3’s. You’ll also want to reduce or eliminate the amount of processed vegetable oils you consume, such as corn, canola, safflower, and soy oil.
Avoid gluten, a grain protein that has been shown to decrease bone density. Gluten is found in wheat, barley, rye, oats and spelt.
Avoid soda and sugar, particularly fructose, which increase bone damage by depleting your bones of calcium.
Optimize your vitamin D levels, ideally through proper amounts of sun exposure. Vitamin D builds your bone density by helping your body absorb calcium.
Supplement with vitamin K2 if you are not getting enough from food alone. Fermented foods, such as natto, typically have the highest concentration of vitamin K found in the human diet and can provide several milligrams of vitamin K2 on a daily basis.
Vitamin K2 serves as the biological "glue" that helps plug the calcium into your bone matrix and is crucial for preventing osteoporosis. I recommend taking about 150 mcg per day.
Make sure your diet includes sufficient amounts of magnesium, manganese, zinc, silicon and boron, or take them as supplements. The best form of calcium is to consume raw dairy regularly. Additionally, cheese is a good source of vitamin K2.
Replace your calcium supplements with natural salts -- Dr. Robert Thompson M.D. wrote an entire book, The Calcium Lie, addressing this important issue. One of the tenets of his book is that bone is composed of at least a dozen minerals, and if you focus exclusively on calcium supplementation you are likely going to worsen your bone density, and will actually increase your risk of osteoporosis!
Dr. Thompson believes that the overconsumption of calcium in the goal of preventing osteoporosis creates other mineral deficiencies and imbalances that will also increase your risk of heart disease, kidney stones, gallstones, osteoarthritis, hypothyroidism, obesity and type 2 diabetes.
He believes almost everyone needs trace minerals, not just calcium, because you simply cannot get all the nutrients you need through food grown in mineral depleted soils. Dr. Thompson believes unprocessed natural salts, such as Himalayan salt, are one of the best sources of these ionic trace minerals.
Avoid steroids, especially if you have asthma or any other autoimmune disease, as they increase your risk for osteoporosis. Steroids are known to destroy bone density by impairing the cells that build bone (osteoblasts).
Exercise. Studies show that exercise is just as important to your bone health as eating a calcium-rich diet. Strength-building exercises like weight training are especially helpful here.
Consider natural progesterone, which can increase your bone strength and density by serving as a growth promoter for the osteoblasts (the cells that build bone).
I will be going into far more detail in the future, but the sex hormones ideally should be applied as a trans mucosal cream, applied in the vaginal labia area or rectum. They should not be applied on your skin and clearly should not be swallowed, so this would also eliminate sublingual drops as it is nearly impossible to avoid swallowing some of the drops.
Of course, it would be wise to have the other basics in place such as adequate amounts of calcium, zinc, magnesium, vitamin D and copper, in addition to exercise and avoidance of foods that will damage your bone, such as fructose and gluten.
It’s important to realize, however, that only natural progesterone will do here. The synthetic version, Provera, will not provide this bone-building benefit. For more on progesterone, please review Complications Regarding Progesterone Cream.
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