HomeFluoridePros and Cons of Fosamax, Actonel, and Boniva for Osteoporosis and Osteopenia

Fosamax tabletsIf you are a menopausal or post-menopausal woman, you may have been told by your physician that you should begin taking bisphosphonates–better known under the brand names Fosamax, Actonel, Boniva, Skelid, Didronel, and others.  Several years ago it was recommended that I take Actonel after I was diagnosed with osteopenia based on a heel bone density test.  I did some research before deciding what to do.  The information I found then did not convince me that I should take any of the bone loss drugs.  Although I no longer have access to that exact information, I remember reading that there was little evidence that the drugs prevented broken bones in women who had not already had fractures, and I had not.  I also read that broken bones correlated most strongly with falling, not to whether or not the patient was taking drugs.  After reading about the most common side effects–upset stomach, irritation of the esophagus, and bone or joint pain–and the very small likelihood of preventing broken bones, I decided that the potential benefits did not justify the risk of side effects, and I did not take the Actonel.

Just recently I was talking to a friend whose doctor had told her that she should begin taking one of these bone loss drugs.  Our discussion of the pros and cons made me think I should take another look at the latest research about bisphosphonates, which are prescribed to millions of people.  What I learned confirmed my earlier decision not to take Actonel and gave me reason to doubt the benefits for many others now taking the drugs.  Here’s what I found, why I’m glad I decided not to take Actonel years ago, and why I would absolutely make the same decision today.

What are osteoporosis and osteopenia?

First I looked for more information about osteoporosis and osteopenia–exactly what are they and how do doctors diagnose them? Osteoporosis comes from the Greek for ‘porous bones.’  It indicates a reduced mineral density of the bone (BMD) that can lead to breakage.  Bone cells die and new ones are created, but as we age the creation of new bone cells slows down which can reduce bone density.  The information about osteoporosis was about what I expected, but what I then learned about osteopenia did surprise me.  Osteopenia, sometimes called pre-osteoporosis, is officially and arbitrarily defined as “one standard deviation below that of an average 30-year old white woman.”  This definition is controversial because there is “no biological or medical reason for using one standard deviation.”  [emphasis mine]  It was defined in 1992 by the World Health Organization and was intended to indicate a possible growing problem.  The definition of osteopenia “didn’t have any particular diagnostic or therapeutic significance.”  So why are so many women diagnosed with osteopenia and told to take bisphosphonates? In fact, more than half of the population probably qualifies as having osteopenia.  Another problem with the diagnosis is that the methods of testing for both osteoporosis and osteopenia are not very reliable, and the diagnosis itself may depend more on what type of machine is used for the test than on the actual condition of your bones.  Bisphosphonates are heavily marketed to women who are diagnosed with osteopenia and who are actually at very low risk of fracture.  Another interesting (but not so surprising) bit of information: the original bisphosphonate drug trials were funded by the pharmaceutical industry and were reviewed by teams that included drug company employees.  Is this another case of drug companies exaggerating risks of a disease in order to market their drug treatments? [Another example, statins for lowering cholesterol]

Men can also have osteoporosis–about 30% of osteoporosis fractures–are in men-but, due to their greater bone mass, men usually break hips, vertebra, or wrists about 10 years later than women. 

What causes osteoporosis and osteopenia

The primary causes of osteoporosis are poor bone growth in adolescence and increased bone loss in perimenopausal women; however, there are other factors that can reduce bone strength. Some are lifestyle habits like smoking tobacco, drinking too much alcohol, and lack of weight-bearing exercise.  Another cause is a diet poor in nutrients such as the Standard American Diet (SAD) which doesn’t have the nutrients needed for healthy bones and teeth, such as vitamins A, D, K, B vitamins, omega-3 fatty acids, and minerals.  In fact, any condition or illness that prevents or hinders our getting nutrients from the foods we eat can cause bone loss.  Some of these conditions are (in addition to the SAD) anorexia nervosa and other eating disorders, celiac disease, inflammatory bowel disease, Chron’s disease, liver disease, and excessive weight loss.  The common practice of feeding dairy cattle grain rather than grass may also contribute to bone loss since today’s conventional dairy milk has only about 30% of the conjugated linoleic acid (CLA) that it had before 1960.  CLA has many health benefits, including increase in bone mineral density.  Many Americans take multiple prescription drugs every day, and lots of these medications can cause bone loss: antacids containing aluminum; some antiseizure medications such as Dilantin or Phenobarbital; cancer chemotherapy drugs; cyclosporine A; cortisone and prednisone; gonadotropic releasing hormone; heparin; lithium, Depra-Provera, methotrexate; proton-pump inhibitors; SSRIs such as Lexapro, Prozac, and Zoloft; Tamoxifen; Thiazolidenediones, Actos and Avandia; and an excess of thyroid hormones. 

What are bisphosphonates and how do they work?

Bisphosphonates are a class of drug that are designed to prevent bone loss.  Bisphosphonates originated in the detergent division of Procter & Gamble in the 1960s when the company was looking for an additive that could be used to soften water.  Soon however the dental division took over the research to help remove tartar buildup on teeth.  The discovery that bisphosphonates could stop bone loss led to the release of Fosamax (alendronate) by Merck in the 1990s.   Our bones are constantly undergoing turnover which is kept in balance by osteoblasts which create bone and by osteoclasts which destroy bone.  Bisphosphonates cause the osteoclasts to slow way down or die thus reducing bone loss.   During treatment, the bisphosphonates accumulate in the bones and can persist for decades, continually exposing patients to the effects of the drugs long after they stop taking them.

Are bisphosphonates effective for osteoporosis and osteopenia?

There is evidence that bisphosphonates reduce the risk of breakage in patients who have had previous fractures; however, they have not been shown to reduce fracture risk for those who have not already had a fracture.  Studies of Fosamax, a commonly prescribed bisphosphonate, show that, for women with osteoporosis, it “may prevent fractures in the spine, hip or wrist, or in bones other than the spine.”  However, in women with more normal bone density, as in osteopenia, Fosamax shows no benefit in fractures of the hip, wrist, or bones other than the spine.  For women with osteopenia, Fosamax may prevent fractures of the spine.  Studies of Actonel, another commonly prescribed bone drug, showed that for women with osteoporosis, it could prevent spinal fractures and may prevent hip fractures, but will not prevent wrist fractures.  The Actonel studies do not show any benefit for women who are diagnosed with osteopenia.  Overall it looks like there is some limited benefit for women with osteoporosis and very little, if any, benefit for women with more normal bone strength.  How small is the potential benefit for women diagnosed with osteopenia?  “Up to 270 women with pre-osteoporosis (osteopenia) might need to be treated with drugs for three years so that one of them could avoid a single vertebral fracture.” [emphasis mine] Even in cases where benefit may be gained from taking the drugs, an analysis published by the FDA “found little if any benefit from the drugs after three to five years of use.”

What are the risks and the most common side effects of taking bisphosphonates?

Since the benefits of taking the drugs seem to be limited, what are the health risks?  Are they worth the small but possible benefit?  The most common adverse side effects from oral bisphosphonates are upset stomach; inflammation of the esophagus; severe bone, joint, or musculoskeletal pain; atrial fibrillation; bone abnormalities; and osteonecrosis of the jaw.  Although the correlation has not been confirmed, one study estimated that 3% of atrial fibrillation cases may have been caused by use of alendronate (Fosamax).  The side effect of musculoskeletal pain has been described as severe and even incapacitating and can occur soon after beginning the treatment or years after starting the bisphosphonates. Stopping treatment doesn’t always give complete relief from the pain, maybe because the drugs remain in the bones for so many years.

Femoral (thigh bone) fractures, an uncommon but serious and well-known side effect of taking bisphosphonates, are termed “low-energy or spontaneous” because they result from falls no higher than a standing person or without any fall or trauma at all.  Fractures of the thigh bone are rare because the bones are subject to high stress and don’t readily break unless there is really something significantly wrong with the makeup of the bone.  How bisphosphonates cause the femoral fractures is not known, but one possibility is that the drugs slow down bone turnover allowing increased mineralization of the bone.  This increased mineralization makes the bones stiffer and more brittle.  The stiffer bones may cause microscopic cracks that the bones would normally repair; however, if bone resorption (death of bone cells) is inhibited by treatment with bisphosphonates, the normal repair process may not be able to take place.  The unrepaired, now more brittle thigh bone may break more easily than normally repaired bone.

When bisphosphonates are administered intravenously, additional adverse side effects can occur.  There can be fever, flu-like symptoms, and osteonecrosis (bone death) of the jaw.  Osteonecrosis can occur when the bisphosphonates work too well.  The drugs inhibit bone cell death which can cause the bones to become too dense.  Too dense bones can displace the space for the bone marrow which keeps the bones alive.

What are natural alternatives to taking drugs?

If you decide, like I did, not to take bisphosphonates, there are natural and effective alternatives to taking drugs.  These alternatives include exercising, improving your diet, and possibly taking  supplements.

First, Exercise is essential. Any type of movement is good for strengthening bones.  When muscles contract, they pull the tendons attached to the bones and send a message to the bones to deposit more calcium thus strengthening the bones.  The best exercise for osteoporosis is weight lifting–join a gym or get some barbells to use at home.  Walking 30 minutes or more a day is basic exercise to improve your overall health.  But don’t forget there are many other excellent ways to get your exercise: gardening, dancing, running, jumping rope, tennis, aerobics, and climbing stairs are just some of them.  They’re all good.  In fact, the best advice is to do whatever activity you enjoy most because that’s the one you will keep on doing.

Second, What you eat and drink can have a profound effect on your health, including your bone strength.  Here are some of the changes you can make to help prevent or reverse bone loss.   Stop eating and drinking junk foods. Some junk foods just displace nutritious foods in our diet, but others are actually harmful to bone health.  Don’t drink soft drinks (the phosphorus promotes bone loss), foods and beverages containing fluoride, caffeine, and alcoholStop smoking.  Add whole Real Foods to your diet.   Studies suggest that our bodies are better nourished by eating foods rich in minerals and vitamins than by taking supplements.  Minerals especially important for bone health include calcium, magnesium, and trace minerals like boron, strontium, manganese, silica, and copper. Nutrient-dense foods include cheese and other full-fat dairy products (preferably unpasteurized), wild salmon, sardines, fish liver oils (e.g., fermented cod liver oil), beef liver, egg yolks, and bone broth.  Natto (a fermented soybean product), cheeses, egg yolks, and liver are good food sources of vitamin K2 which has been shown in Japanese studies to reverse bone loss in people with osteoporosis. The Japanese studies found K2 supplements caused a 60% reduction in spinal fractures and an 80% reduction in other fractures.

Third, If you find it difficult to eat enough nutritious foods, you can add supplements, although they are not as beneficial as getting nutrients from whole foods.  Multi vitamins and minerals, including trace minerals, from good sources may be useful.  Fermented cod liver oil is an excellent source of vitamins A and D and omega-3 fatty acids.

What do I do to keep my bones strong?

Since I decided that I would not take drugs for osteopenia, I thought it was important to focus on healthy ways to prevent bone loss.  Here’s what I do:  I exercise six days a week, at home; I don’t go to a gym.  The exercises include using free weights, stretching, Chi Kung, and sometimes Tai Chi. [Update September 2015:  In 2014 I added a 30 minute yoga routine to my morning exercise and have seen benefits to my joints and in my flexibility.]  I have eliminated all soft drinks, most processed food, most sweeteners, and most junk food. [We do eat out once or twice a week which I usually put in the junk food category.]  My family eats grass-fed beef, pastured or organic poultry, mostly local and/or organic vegetables and fruits, whole raw milk products, and yard eggs. I eat probiotics, such as kefir, kombucha, or fermented fruits and vegetables with every meal. We have greatly reduced, but not eliminated, grains, and the grains we do eat are sprouted or soaked to reduce the toxins and improve digestion.  We eat bone broth and lots of homemade soups made with bones.  I do take vitamin and mineral supplements (including fermented cod liver oil for A and D and high vitamin butter oil for K2) because my diet in childhood and adolescence was so poor that I’m sure I have deficient bone strength.

Commonly prescribed bisphosphonates, their generic names, and their manufacturers

Fosamax, alendronate, Merck
Actonel, risedronate, Proctor & Gamble
Boniva, ibandronate, Roche
Skelid, tiludronate, Sanofi
Didronel, etidronate, Procter & Gamble
Reclast and Zometa, zoledronic acid, Novartis [intravenously administered]
Aredia, pamidronate, Novartis [intravenously administered]

Update November 22, 2012: Osteoporosis Myth: The Dangers of High Mineral Density explains how a “desease,” osteopenia was manufactured from the normal bone loss due to aging.  If someone’s bone density is compared to his/her appropriate age group, the vast majority of people (usually women) “diagnosed” with osteopenia will fall out of the category.  An additional problem with measuring bone mineral density (BMD) is that it is NOT a measure of bone strength.  In some cases of high bone density, the bone is actually weaker, not stronger.  Also, higher BMD in middle-aged and older women is associated with a 200-300% higher risk of breast cancer.

Update, December 5, 2012: A new study has found that “Women with higher cholesterol levels have significantly higher bone mineral density.”

Update, May 9, 2013: “A new study published in The Breast Journal, authored by researchers at the Department of Surgery, St. Luke’s-Roosevelt Hospital Center, New York, NY confirms numerous past studies showing low bone mineral density lowers the risk of breast cancer.” [source]

Update, July 6, 2013: A new study identifies the harmful effects of statins and bisphosphonates on bone health, Statins and Bisphosphonates Inhibit Menaquinone-4 Biosynthesis in Bone

Update, September 4, 2014:  A new Swedish study finds that taking bisphosphonates can risk fractures of the thigh bone.  “For those who took bisphosphonates for four to five years, the so-called ‘relative risk’ was 100 times higher than among people who didn’t use the medications.”  While the risk may be worth the benefit for people with osteoporosis, for those with less decrease in bone density (sometimes called osteopenia), the risk may be greater than the potential benefit. [emphasis added]

Update, September 15, 2014: Vitamin B12 is necessary for proper bone growth.  “Older women with low levels of vitamin B12 experience significantly more rapid hip bone loss – a sign of osteoporosis – than women with higher levels of B12.” “The best dietary sources of vitamin B12 are animal products like organic grass-fed beef, chicken, raw milk, and eggs.”  [source]


Bisphosphonate, Wikipedia
Osteoporosis, Wikipedia
Osteopenia, Wikipedia
How Bisphosphonates Work
New Cautions About Long-Term Use of Bone Drugs
Bisphosphonates for Osteoporosis–Where Do We Go from Here?
Subtrochanteric and Diaphyseal Femur Fractures in Patients Treated with Alendronate
US FDA Safety Announcement (10-13-2010)
Severe Pain with Osteoporosis Drugs
The Bisphosphonate Story From Detergents to Bone Disease (a history of the development of bisphosphonates in the treatment of osteoporosis)
Alendronate [Fosamax] for the primary and secondary prevention of osteoporotic fractures in postmenopausal women
Risedronate [Actonel] for the primary and secondary prevention of osteoporotic fractures in postmenopausal women
Preventing Osteoporosis with Nutrition
Drugs for pre-osteoporosis: prevention or disease mongering?
Low-Energy Femoral Fractures Associated with the Long-Term Use of Bisphosphonates
Osteochemonecrosis of jaws and bisphosphonates
t10c12-CLA maintains higher bone mineral density during aging by modulating osteoclastogenesis and bone marrow adiposity
Other Causes of Bone Loss
Osteoporosis Myth: The Dangers of High Bone Mineral Density
Osteoporosis–Natural Help for Strong Bones
Osteoporosis Prevention Through Nutrition and Diet
Strontium Treatment for Osteoporosis
Osteopenia Treatment
Preventing Osteoporosis with Nutrition

Photo credit: Alendronic acid (Fosamax) tablets

This post is shared on Fat Tuesday, June 19, 2012


Pros and Cons of Fosamax, Actonel, and Boniva for Osteoporosis and Osteopenia — 59 Comments

  1. Thank you for sharing your research! I am a post menopausal woman who has been diagnosed with both osteoporosis and osteopenia and was prescribed medication. I also decided against taking the estrogen based drug and am working with a naturopath on improving my absorption (have always had IBS issues.) I also wonder about the long term effects of these drugs and whether they truly help though the fact that I am only 54 & broke my collarbone in a hard fall at the gym does concern me.

    • I’m glad the post helped. It looks like you are trying to improve your bone health. Being concerned can lead to improved health. Your naturopath may have already suggested this, but for your IBS issues, you might consider looking into the GAPS (Gut and Psychology Syndrome) diet from Dr. Natasha Campbell-McBride. GAPS targets healing the entire digestive system.

    • Thank you so much for taking the time to do the research and putting it out there for people. I have been diagnosed with osteoporosis and osteopenia in my hips. I was really struggling with the idea of taking the Boniva that was prescribed for me. The risk of taking the Boniva outweiigh the risk of taking it, thst is what I’ve taking away from this information. I’ve decided not to take the medication. I will be changing my daily routine and diet. Thank you.

  2. I am so glad I have read your information about bisphosphonates. I have been taking Fosamax for almost 3 years and have been getting increasing lower back and hip pain for the past year. I just decided that this is not normal. My doctor had an MRI done, and I was told that I have arthritis. I experience grinding and popping feelings and sounds in my lower back along with the pain. I have been exercising and doing more to correct my diet. I realize now that I have been my own worst enemy, by avoiding doing more to help myself with diet and exercise. At 56 years old, I feel like I am really old. This has happened to me since I started taking the Fosamax. Your insight has helped me to make the decision to stay off of the drugs and work my problems out naturally. Thank you.

  3. I have been hurting badly with all my joints and bone. I decided to look online to see if fosamax was related to any of these problems. So glad I read this. I went of fosamax today after 3 years. I sure hope some of this pain goes away now. I have had so many cortisone injections to help me with the pain I’m sure fosamax was causing. I do work out everyday and eat fairly well. Well written, I enjoyed reading it.

      • Dear Dr. Dach: What an INSANELY IRRESPONSIBLE thing for you to say. You have NO SCIENCE to back up such a statement. The rlatiey is that bisphosphonates are WELL PROVEN with double blinded, randomly controlled studies to REDUCE FRACTURES in those at the most risk. If there appears to be a link here, then it should be thoroughly investigated with SCIENCE, as opposed to blanket statements by “doctors” with CLEAR CONFLICT OF INTEREST. Maybe there is a role for a drug holiday, maybe there are predisposing factors in these particular individuals such as drug-drug interactions. To impugn an entire class of medications with undeniable benefit to humanity: YOU ARE RECKLESS, BIASED, AND IRRESPONSIBLE. Your statement carries weight purely because of your “Dr” in front of your name. For god’s sake, your a freaking radiologist who went to a bio-identical hormone seminar, and suddenly became an “expert”: god bless america. You speak of the financial motives: oh yes, you clearly are above such influences. You are a hippocrate. A few case reports does not make a study. If there appears to be a link, then it should be, and is being, investigated. However the fact remains that bisphosphonates are beneficial to humanity, especially those with osteoporosis and thus at tremendously high risk of both vertebral compression fractures and femur neck (hip) fractures. Your statement is analogous to me saying bioidentical hormones such as estradiol causes fatal blood clots, strokes, heart attacks, and breast cancers and should be banned by the FDA. Though the side effects are real, they are relatively rare and the bad does not necessarily outweigh the good.S.Lynch MDPS: “Bio-identical” Estradiol is $4 per mth at Walmart: ask your “tainted” main-stream doctor for a prescription today and skip your trip to the “hollywood radiologist bio-identical specialist”.

    • Dear Dr Lynch,Perhaps you should also be clnilag insanely irresponsible the 2010 AAOS meeting which presented studies from the Hospital for Special Surgery (HSS) and Columbia University Medical Center which showed that Fosamax disturbs bone formation, and implicated Fosamax in spontaneous mid-femur fractures (without trauma).Perhaps you should also be clnilag reckless, biased and irresponsible Clarita Odvina MD who reported nine cases of spontaneous femur fracture on Fosamax. Or Dr. Goh, a doctor in Singapore, who identified nine more cases in his 2007 report of subtrochanteric femur fractures with minimal trauma in women on long term Fosamax. Or Joseph M Lane MD who reported 15 cases of spontaneous femur fracture in women on Fosamax with a unique radiographic pattern.Rather, I would say it is insanely irresponsilbe to give women a drug that causes spontaneous mid femur fractures, jaw necrosis, and diffuse bone and joint pain. You don’t need a double blind placebo controlled study to show a drug disturbs bone physiology. The histology slides don’t lie. Conflict of interest? That is a laugh. Drug companies clean up on Fosamax,a 3 billion dollar industry. Now that kind of money can generate a real conflict of interest, documented by Aubrey Blumsohn MD who blew the whistle on the Actonel studies.jeffrey dach md

  4. I have been diagnosed with osteoporosis (at age 77 and healthy but with a hyper thyroid condition) and my doctor has prescribed Fosamax. I have always been inclined to check the side effects of prescription drugs and careful to avoid taking drugs that have damaging side effects. I found this article informative and the comments of those who have taken bisphosphonates even moreso. Before picking up my prescription I am going to share this article with my doctor and see what his thoughts are for using an alternative, like taking calcium supplements. I eill appreciate hearing from anyone who has experience with Fosamax as a remedy for osteoporosis.

    • I’m glad you are researching the side effects and implications of taking bisphosphonates. I believe all of us should learn as much as possible about our health care recommendations. Be sure to check out the updates added at the end of the article for the latest information on osteoporosis and osteopenia. I hope you get improvement for your health issues.

    • Hi Gerry,
      Have you discussed with your doctor? What was his/her comment?
      I was first diagnosed with hyperthyroid, and my endocrinologist recommended me to do the bone density test from which we discovered that I had osteoporosis too. I was prescribed with Alendronate (Bisphosphonates). My mistake was that I did not research enough, so I took it since last May this year. I had not had any bone fracture before, so I was so stressful if my osteoporosis will cause it one time. I am thinking twice now to continue taking it after Carolyn explained how the bisphosphonates works. It’s so scary if it works too well for me and causes osteonecrosis. So, please Gerry, share with us what your doctor said. Thank you. Thank you so much to you too, Carolyn for sharing with us your research.

  5. Today my bone density test showd that I have osteopenia. The doctor is pressing me to go on a bisphosphonate medication. I am skeptical. I am on the statin, Lipitor 20 mgs. daily. I am interested in the natural supplements to keep my bones strong. I am 60 years old ,135Lbs. @ 5’3” tall. Could you advise the proper dosage for me of the femented cod liver oil for A & D and the high vitamin butter oil for the K2? I do take 400 mgs. of D and 500 mgs. of calcium( 2x daily ) plus calcium rich foods.

    Thank you,
    Katherine Owens

  6. Thank you for the wealth of information. I have never” been sold ” on my need for statins. But, when my overall cholesterol reached 300 and I couldn’t tolerate the high dosage of Niacin prescribed to me, I” caved”. My HDL is always in the upper 80’s/90’s range and my Triglycerides and LDL normal. My doc has me taking 20mgs daily. My diet is healthy. High Cholesterol in genetic in my family. I would like to stop taking the steroid. Should I just do it of consult my doctor first?

    • Since your high cholesterol is genetic, you may have familial hypercholesterolemia (FH). Although there are differing opinions about the cause of FH, I would not recommend that you change your medication without consulting your doctor. You might want to read Fat and Cholesterol are GOOD for You! by Uffe Ravnskov, MD, PhD. Dr. Ravnskov discusses FH in the chapter “What Good Cholesterol Does,” beginning on page 29 (in my copy).

      Dr. Mercola says that if total cholesterol is 330 or below and the ratio of HDL to total cholesterol is greater than 25%, your risk of heart disease is probably low. Given your total cholesterol of 300 and your HDL of 80 to 90, then your percentage would be 26% to 30% within the low risk range. He says if the ratio falls below 15-20% then you are at high risk. Read more: Tips to Lower Cholesterol Naturally.

      More information about natural ways to lower cholesterol: The Cholesterol Myth That Is Harming Your Health.

  7. I’m so confused by conflicting studies on calcium, vitamin D and bone density drugs. Sometimes I think we are all just lab rats. I’ve been diagnosed with Osteoporosis at the age of 69 with T scores between -2.4 and -2.8. I walk 25 miles a week, eat a diet rich in calcium, get plenty of vitamin D and have no desire to take drugs. Small bones, white ethnicity and heredity however may require me to do so.

    • I am not a health practitioner, but if I were faced with your decision I would try nutritional solutions for a few months before using drugs. Your diet may be good, but, if you are not already drinking bone broth every day, I highly recommend it. I drink at least a cup a day of homemade bone broth, made with healthy bones from pastured animals. There are lots of good recipes for bone broth on the web, but here are mine, Bone broth from pastured chicken and Meat Stock or Bone Broth–which do you make? For a few months drink a minimum of a cup each day of homemade bone broth and then get retested. If your calcium rich diet is primarily from vegetables, you might try to get more calcium and other minerals from animal products, like raw milk and/or raw milk cheeses, sardines (with the bones) because those minerals are more readily absorbed by the body.

      Also, you don’t mention taking any drugs, but statins can inhibit healthy bone growth. Other prescription drugs may also reduce bone density. Another study referenced above in an Update, found that higher cholesterol levels improve bone density in women. Women are especially vulnerable to the harmful effects of low cholesterol levels, which can be caused by taking statins.

      If you have not already had a bone fracture, no study that I am aware of has shown that bisphosphonates reduce future fracture risk.

      Before making your decision, read the articles referenced above and also do your own research. The absolute best thing you can do for your health is to be fully informed about whatever condition you may have.

      Good luck with your decision!

      • Thank you for your most thoughtful and prompt response. I do not take drugs – in fact no prescriptions for almost 40 years. I never missed a day of work due to illness, was a runner before a walker and have maintained a healthy weight.

        Not only have I not experienced a fracture, I fell backwards onto concrete and landed on my wrist while pulling down my garage door (power was out). Hurt like heck but no break. I am currently having a hard time believing the diagnosis and have little faith in the medical profession.

        I will try your nutritional suggestions and continue my exercise routine.

        Thank you, Andrea

      • Women should have both DXA bones scans and FRAX qoiitsunnaeres to determine whether they need this class of drugs. Very few women get these atypical subtrochanteric femur fractures, which doesn’t help if you’re one of them.In a recent study, more than one-third the women who did have these fractures were taking a bisphosphonate (but that also means two-thirds were not). It’s a question of weighing the risks. It appears the most likely femur-fracture victims are younger, more active and the medication for a long time. Some seem to be on other drugs as well. (June 2010 issue of More magazine has an excellent article on this.) Some doctors are recommending alternative medications if a patient is in her fifties than if she is in her eighties. More says “One scenario might involve a patient taking a low dose of estrogen close to menopause to protect bones and help with menopausal sumptoms, followed by Evista to reduce the risk of breat cancer and oseoporosis, and then use bisphosphonates if needed later in life when hip-fracture preventuion becomes increasingly important.” That takes both an active patient and an active doctor who do research, are willing to investigate alternatives, and keep tabs on their health. There’s no doubt that bisphosphanates are viable in preventing hip fractures for a certain population. Preventing that population from obtaining them is tentamount to refusing a vaccine to the population who needs it because a small population suffers from severe side effects. As a woman in her fifties whose doctor prescribed Fosomax, I’m taking myself off it (with the approval of my doctor) after 4 years. I am genetically predisposed to osteo but I am too young to take this drug, based on all the research I have to date. Individuals need to be proactive about researching their own situation and work with a doctor who is open minded and up on modern study results.

  8. I took Boniva for five years the first two years no problems but into the third year I noticed that my joints were really aching and my thigh bone felt like the muscle was pulling away from it. I thought at the time it was arthritis but I have now been off of the Boniva for three years and the joint pain I had has stopped even the problem with my thigh has gone away. I really think it was the Boniva that was causing my problems. There were times that I could not get up off the floor if I sat down on it because my joints hurt so bad. Now I get up and down with little trouble of course not like I did when I was in my twenties as I am 66 years old now but I can still get up without the help of someone. I tripped and fell into my cabinits last Sept and all my weight and I was 25 lbs. overweight at the time went against my wrist and it shattered but I don’t associate that with the osteoporosis as it was a very hard and fast fall with all weight going aganist my tiny wrist. So I don’t even like the idea of taking that medicine again hopefully I won’t have to. Thank you for your posting.

    • I am glad that your pain went away when you stopped taking the Boniva. Since bisphosphonates accumulate in the bones, the adverse effects of the drugs may continue long after stopping. Continuing with a nutrient-dense diet and exercise can help strengthen your bones.

  9. I have been diagnosed with osteopenia and began taking actenol three months ago, the once a month dosage. After taking it this past month I have suffered from nausea and constipation, belching and burping all of the time. I have been checking out diets and exercise so that I can stop taking this medication. I found you article very helpful. I will be seeing my doctor next week to discuss getting off of the med and going a different route.

    Thanks so much, Evalynn J. Alu

  10. I’m just about to turn 60 years old and have been diagnosed with osteoporosis (t-scores range from -1.9 to -2.5; 3 years ago they ranged from -0.9 to -1.9). Fifteen years ago I broke my ankle and required surgery; 6 years ago I broke my foot (base of the 5th metatarsal) when my foot slipped off my shoe; 3 years ago I broke my wrist (turned directly into a chair lift when skiing). I’m Caucasian, small-boned and although I take a multi-vitamin, plus calcium and vitamin D, the past few years have been particularly stressful, making it difficult to properly address my own well-being, due to serious family health issues/death in addition to major work demands. Which means that although I took the supplements I took then when it was most convenient – when I woke up and when I went to bed – rather than when they would be best absorbed. I didn’t make enough time to exercise nor did I focus on my diet as well as I should have. My doctor has prescribed Fosamax and when I suggested that instead I make a concerted effort to properly take care of myself she urged me to go on the medication for a period of 3 years while at the same time making sure I get calcium and vitamin D and ensure I do weight-bearing exercise. At that time she would like me to get another bone density test and if the levels are below current levels go off the medication and continue with the focus on good diet, exercise and possible supplements. She said, and I’ve heard elsewhere, that the changes in bone density are so gradual that having tests done too close together won’t guarantee an accurate picture of either bone growth or bone loss – thus the 3-year timeline for treatment. I do have some history of broken bones (and breaking a bone by slipping off a shoe does sound problematic, even to me), but does that, along with my t-scores make the Fosamax a more reasonable option for me? I realize none of us have a crystal ball, but I’m already mad at myself that I didn’t do what I needed to do when I had the warning of osteopenia and don’t want to make the wrong move again. Thanks much.

    • Diane, I sympathize with your health problems, but I am not a health practitioner and can’t advise what you should do. You must do your own research about how Fosamax works and the options available to you. Discuss your questions with your doctor. You might get a second opinion if you still have concerns.

      I know from personal experience that sometimes the damage to our health caused by poor medical care or poor nutrition cannot be completely reversed. Most important is for you to stay informed about all treatment you are given. Learn what it is supposed to do and what the side effects are. Be an active participant in your own health care.

      I hope you find help whatever you decide to do.

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  14. Hi
    I am 67 w a T score of -2.8. I went on.fosamax for 2 yrs in 08-09. I read about ONJ and while having my teeth cleaned the
    DDS mentioned visible bone loss on upper right 2 back molars. I spoke w my GP and refused to take it anymore. In 2010 i lost both teeth, pluz the lower left molar. It Ffrcted how i ate due to chewing. I was asking for an upper partial plate just so i would have so
    E place to chew. My DDS of 10 yrs he was not comfortable in.maki.g it.
    I changed DDS and told him what i needed. We talked for over an hr.about his concerns: Fosamas for 2 years, menapausol, smoker and hypothyroid which went undiagnosed for about a yr in 2009 (multiple deaths in short time siblings children. 4 siblings loss kids betweew ages 18, 23, 24, 26 and 29 — all w/in 1-1-2 yrs, some being one mo. apart and 4 mo. apart. It was a very devastating time formy family and self.
    I have gensfic hypercholesterol but eat heathy and numbers are e ellent. If i drop the 20mg day statin it goes up.
    I have always been very active until 2012. I retired as Medical Massage PrTitioner for 20 yrs w no injuries; dix yoga 3 x’s a wk; walkex 2-3 miles 5 days a week and take care of 3/4 acres of yard w leaves, pineshats, pinecones, clipping trees, cutting trees w chain saw and cleani.g my house. Low fat diet, lots of steamed vegies, very lite red meT. I take Vit: D, 6000/day, Calcium 1200/dat, E 400 units/day, zoloft due to anxiety that came from hypothyroid (i think it was the cause for imbalance of hormones w all the stress). I take 0.5 (1/2 mg) xanax to sleep, zertec for allergies, 1000 units of fish.
    Back to the affects from FosMax. Bone loss in jaw sbowed up in 2010 w 3 extractions leaving a large hole on right uppe molor. A pencil erasure would easily fit in the hole.
    I went to TX to care for my sister approaching a double lung transplant and stayed for 13 mos. I fractured my L1 and docs did not x-ray or test and treated it like a muscle spasm and loaded me up w muscle and pain pills. I toom 1 day and threw up for 5 hrs. On bedrest for 3 wks. Sis had transpla.t 2 wks later; spent 26 wks in ICU, hospitals, Rehab and slept on floirs, window sills, no sleep due to her 7 wk endurance of hallucinations and C-dif and had a stroke during survery and loss use of left arm (which i was able to do massage for 3 wks to restore); she also.lost her eyesivht during the stroke. Quite stressful. She was dead weight and weivhed twice
    my size. I’m 5-3-1/2 and lost 13 lbs taking me down to 113. From meds it required me to hand feed her meals, and administereng her bi pap machine for clearing lungs, hand/arm tberapy. Keeping her oral hygiene (thrush) cleaned 3x’s a day, making skin was clean, cleaning and redressing often 7 times from 6-11 am.
    I was exhausted when i came back to MD. Took a out a yr to recuperate.
    In November 2013! i fractured L2 and told me about old fracture L1. They also found a menigioma (brain tumor) on Spinal cord covering and left it. I.was bedridden for 2-1/2 mos and placed on Fosamax again. In June 2014 i finally a found a DDS to (after co sulting w 2 DDS, 1Peridontist and Orthodonic all refusing to touch my mouth.
    The oral surgeon who ended up doing 4 jaw surguries from June 16-November 16 using a method called PlSma Rich Platelets (PRP). They use your own blood, spin it, cut a flap in jaw bone and inject blood and stitch it for 3 wks to grow new bone w the platelets. For me, it took 4 surgeries and 24 vials of blood bc i have low platelets which Fosamax also affects (also Zoloft). I became enemic and had to wait until for my RBC to come back up. My GP sent me go Hematologist who diagnosed me with ITP ( low platelets). Then i had a choking event w a small piece of apple and dry cough for about 10 min. and sneezed very hard 5 times really hard. Woke up w excruiating sore throat and ear ache for 3 weeks a.d my lower abdomi.al blew up like i was 6 mos. pregnant after eating 1/2,bowl of home made chicken soup. Went an ENT who diagnosedme w Silent Reflux which affects pharnxy, larnyx and esopagus (also side affect from Fosama GP took me of of Fosamas after 9 mos. and suvgezted taki.g the Proclast shot 2 x’s/yr. I was scare of side affects. Didnt like any of the choices that i researched. Meanwhile some of bloodwork showed compromised immune system and malnutrition. Negative for Celiac Disease. Hema doc sent me to Stomach/liver/spleen doc bc ultrasound found enlarged liver/spleen. Wants biopsies of both + esophagus and small intestines. Jaws are done and empty
    spaces mini implants. Report said: Sinus Augmentation due to severe bone loss and Osteo Necrotic Jaw where teeth had been extracted in 2010. Its taken me 3-4 yrs to finally resolve the chewing issue. Summary of Fosamax for me: ONJ, Silent Reflux, Gastrointestinal issues, low platelets. Currently, i take CalciumD3 w fat foods for absorption. No meds for osteoporosis, tired all the time and have lots of limitations physically and reflux has affected my asthma and breathing in middle of the night.
    Im at a loss for what to do. Ive see. Commercials for bone supplements that they claim heals osteo issues — $97/mo.
    I contacted a lawyer and intend to sue Merck. This yr has been horricfic w all of the issues ive mentioned .ot to mention how it has changed my lifestyle.
    I would warn anyone a out Fosamax. They know it does it but makes boocoo bucks even w lawsuits being paid out. Thanks for your patience bc i k ow this was long but it mivht be helpful to others.

  15. I am so grateful to you, for posting this wonderful article. It’s just in the nick of time for me.I am 67, & have taken first Fosamex, and then Boniva, for over 7 years.I’ve been off them for a few years, but not only didn’t it help my T scores. which are -1.5, but I have had so many bone fractures- both ankles, 3 bones in my humorous (shoulder)& this past Sept., surgery w/a plate for a broken wrist. Now that I finally went to a bone Doc, she prescribed actonel. I was going to have the prescription filled, but I was very unsure of it helping.Thanks to you, I will NOT be taking it. I walk 4 miles a day, 5x a week, but only in good weather. I haven’t been doing resistance or weights, which I plan to start ASAP. My cardiologist advised against taking more than 800mg. of supplemental calcium, so I do try to get a lot of calcium from my diet.I am hypothyroid, & taking synthroid for 30+ years, plus PPI’s, both didn’t help my MBD. I’m off the PPI’s, & starting taking probiotics instead, 2x a day, which have helped get rid of any heartburn.Unfortunatley, I hate bone broth, liver, eggs, etc.I do eat a ton of high fat cheese,. Do you have any advise for me?

  16. I just read the recipe for bone broth- which is basically homemade chicken soup.I only eat it once a week, but now that I’m following your advise, maybe I should have it more often. I buy chicken bones, which is the carcass of the chicken taken off, but is mostly bones. If I find beef neck bones, I add them to my soup. I also add fresh garlic & ginger for it’s anti-inflammatory properties, & whole peeled butternut squash & zucchini for flavor. I have two questions, though- 1- why do you need to add vinegar? 2- I only cook my soup for two hours. Does cooking it for 6-24 hours, make any difference?

  17. I have been taking Actonel for many years – more than 10 – and when I went to the dentist with severe tooth pain. He needed to remove my tooth but when he found out I had been on Actonel for so long he wanted me to wait for 7 months before he extracted my tooth. I had it removed anyway. He said that people should not be on Actonel for more than 7 years. I am having a problem now with my tooth area but not as severe as it might have been.

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  19. I am 81 years old in and perfect health .I take only Vitamins .Last week my doctor suggested that i take Boniva because I was diagnosed with Osteoparosis . I did not like the sound of it so I decided to look it up and that is how I saw your wonderful article. I absolutely will not even think of putting that nasty Boniva in my system . I am an active dancer,dancing 3 times each week. I go to the gym every day for one half an hour. I run for 15 minutes on the treadmill and i do 15 minutes of extreme yoga stretching .I watch my diet and take care not to gain any weight .I eat all vegetables and do not believe in the organic mystique .I have had a face lift with a first rate cosmetic surgeon and a breast reduction (the best thing I ever did )and that has given me 20 additional years of feminine youth and allure .Your article has totally confirmed my suspicions about the financially driven campaign to terrify women so they will purchase this toxic so called medication. What I will do after reading your article is to cook some bone soups and add that to my diet . Also I am taking vitamin K and D.Thank you again for the wonderfully generous and informative information .It has been a blessing and a gift .

    • I am so glad that you found the post helpful. Your comment is encouraging. I hope you live well and healthy for many more years. I have added a basic yoga routine to my morning exercise at least 5 days a week. It seems to be very beneficial.

  20. I just recently found out that I have Osteopenia with Rheumatoid Arthritis. When I was first diagnosed they said I had Fibromyalgia. When I finally was able to get into a Rheumatologist he said I could have some Fibro but more of the other two. I have been through so many different medications that I lost count, trying to feel better. I woke up one morning and could not move my neck, the muscle from my shoulder up into my head was hurting so bad. My regular doctor put me on Diclofenac and I could not believe the relief I had from the pains. The pain went away and I actually felt better, my migraines were gone and the pains were gone. I asked my doctor if I could just stay on them and he said no. My migraines returned so he sent me to a Neurologist who ran test after test (this was before I seen the Rheumatologist). We tried a few more new pills and finally I just asked her about the Diclofenac. She said if is helped lets put you back on it and keep you on it. Long story short, my mother had Osteoporosis, my older sister has it now so I thought I had better get into see a Rheumatologist soon so I don’t have the same problems. Well, soon enough that we may be able to reverse the bone loss I have now. The Rheumatologist wanted me to start on Fosamax, I didn’t because I had heard of all the bad things it could cause. I take Raw Calcium (3 a day) that has Magnesium, D-3, K2 and MK-7 in them, the K2 helps everything stay in your body instead of just going out. I also take an extra D-3 because my D is so low. Instead of the Fosamax I take Astaxanthin Gold twice a day. At night I take 1/2 tsp of liquid Magnesium to also help with the Charlie Horses in my legs. The health food store told me that regular Magnesium just makes the water in your body go to your bowls and makes my IBS worse, but the liquid does not. I’m hoping that the Raw Calcium, D-3, Diclofenac, will help with the Arthritis. If anyone knows of anything better please let me know. I have been doing more exercising, and trying to eat better. Thanks

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  22. I also read the article with interest. I have been taking Actonel for I guess 5 years now. I really do hate taking it but I broke my shoulder 5 years ago and was diagnosed with osteophoris. I have in the past six months changed my diet for the better and will stary going again to the gym. I get a bad rash of sorts mostly on my arms chest and groin area and I suspected it was the Actonel causing it. I take the Actonel(150 mg ) monthly so I took it in July and skipped August and guess what, no rash. Do you think if I took it one a week ( 35 mg ) instead of the 150 all at once it might lesson the rash. I know this is just info for you but what do you think?

      • My dentist wouldn’t extract my tooth because I was on Actonel. He said it has no benefit after 7 years. He wanted me to wait several months after I stopped taking Actonel to extract my tooth. I was in too much pain to wait. I checked with my doctor and he said yes he had heard of the dangers. I am ok so far.

  23. I have some typing errors in my previous email. Sorry about that. I meant to say if I took the Actonel weekly instead of the 150 all at once would that maybe help to lessen the rash.

  24. I’ll be 64 next month and have been taken actonel for three years. I take aspirin, a daily vitamin and eat well. I’m a little short on exercise, but I can remedy that. At my last bone density scan a few months ago, I was told that my bone density has improved, pushing me to the upper edge of osteopinia. Great. Meanwhile, I’ve had steadily growing pain in my hips, and in the last few months my shin bone in my right leg and the muscles around it have begun to ache very painfully. Recently I had nerve pain in the leg that made it nearly impossible to walk. If I stopped for a moment I could take a few more steps before it stopped me again. In a panic over this I went to my doctor and he gave me a cortisone shot and scheduled an appointment for me with a neurologist (pending). The shot helped my nerve pain for three weeks, but now it’s back, along with the deep bone pain. I have also developed muscle weakness in one leg in the past year.

    I have suspected that the actonel could be a source of some of these issues, but what I’ve read here makes me seriously concerned. I just filled my three month prescription today. Now I’m thinking this might have been a waste of good money. At any rate, I don’t see how stopping the drug for a few months can do that much harm. I’m going to discuss it with my personal Dr and the neurologist and then see what happens.

  25. I loved this site. I am a 67 yr old woman & just began seeing a holistic Doctor. My diet has changed completely, & I ordered an exercise video 4 seniors online. I exercise 3xwk & I do warm up exercises 6 days a wk. I have osteopenia & have been on Ibandronate 150 mg 1xmonth for more than 6 yrs. ..Now that I am eating right (I have a very colorful diet) & exercising (and have eliminated carbs & sugar & soda, etc), I feel so much better. I’m also taking supplements that my holistic MD advised me to take. And, after reading your article, I see no need to continue taking Ibandronate. Lately I have noticed shoulder pain, & my Dentist said I didn’t have enough bone for a small implant… I have a question: Can I buy raw cheese & raw calcium D3 in a health food store? And if I cook liver, can I fry it extra virgin oil? ..Thx so much for the info about cholesterol numbers. Thx, thx., thx.!!

    • I’m very glad this post has helped you and that you have a holistic doctor. Yes, you can sometimes buy raw milk cheese in a health food store or grocery store. Ask which ones are made with raw milk. You can also get D3 in a health food store. I prefer to get my vitamin D and vitamin A (they work together) in fermented cod liver oil. I use Green Pasture brand. Read here for more information about the benefits of cod liver oil and dosage and other brand recommendations.

      If you can’t find a local source of raw milk cheese, you can order it online (see Real Food Houston’s Resources page).

      Another great way to find healthy, nutritious foods, including raw milk cheese, is the Find Real Food website. Find Real Food is also available as an app on iPhone (search for WAPF). As of January 2016, use of the website is free for a limited time.

      Extra virgin olive oil is best used in uncooked foods like salad dressing or low-temperature quick cooking. A better fat for cooking liver would be lard, tallow, duck or goose fat, or coconut oil, all of which can handle higher heat better. My favorite way to cook liver is with bacon and onion. Cut the bacon into inch size pieces, chop the onion, and cut the liver into bite size pieces. Cook the bacon until browned, add the chopped onion and cook until translucent, then add the liver. Cook the liver just until done. Don’t overcook liver.

  26. I was on Fosamax and developed a-fib which my cardiologist treated with nothing for a number of years. I even passed out from it which I was told that only 50% of people who pass out will regain consciousness. Then my sister told me to stop Fosamax and the a-fib went away. My cardiologist didn’t believe me so he implanted a loop monitor which I wore for 3 years and it proved that I had no episodes of a-fib any more,so I guess he had to believe me after that. Then I went on Boniva and got severe bone pain in my long bones of the leg. I stopped that and my doctor put me on Actonel and I stopped that when I got more pain. Now a number of years after I have been off of all of them I still get severe pain. It starts in my jaw and goes into my neck and then into the middle of my upper back. I have even been to the ER 2 times and they can’t come up with anything. I believe that all of this is caused by Actonel or even all 3 of them. Does anybody else have this type of pain. I don’t have the jaw problems that Fosamax caused. My sister does have that problem.

    • Your conclusion about the cause of your a-fib may be correct. Some studies have shown a correlation between bisphosphonates and a-fib. Also, unfortunately bisphosphonates can be stored in the bones for years and can continue to cause pain for some time after stopping them. Studies have shown that there is little to no additional benefit from taking bisphosphonates for more than 3 to 5 years.

      I hope you get relief from your pain.

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