INDICES> bone density and biphosphonates

[Geraldine Bartlett <bartlett@icon.co.za>]

INDICES> bone density and biphosphonates
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Hi,

I would like some input on the necessity of long term use of 
biphosphonates. We notice that several post-menopausal women with 
osteopenia (and osteoporosis), are often put on biphosphonates. (We are 
aware that the first line treatment is HRT ). In fact, for most of these 
women it is very common to see them on a combination of HRT and 
biphosphonates where the therapy has been started as the combination of 
these two drugs. We are then finding that after about two years and 
longer on the biphosphonate, their bone density has increased and they 
are then within the accepted range ie no longer osteopenic.

>From the literature, it appears that after about 3 years, there may not 
be further increase in bone density by using the biphosphonate. I would 
like to suggest that when patients reach acceptable bone density levels, 
the biphosphonate could then be withdrawn and they should be left on the 
HRT alone which should prevent loss of bone mass. I am trying to find 
information to support my theory. Can anyone help?

>From our drug therapy reviews, we find that once someone is put on a 
biphosphonate, they seem to be on it forever as the prescriber fears 
that if they are taken off the drug, they will revert to losing bone 
mass again. However, if the patient is retained on the HRT, they should 
not lose the bone mass they have gained provided their lifestyle 
modifications (calcium diet and exercise) continue to be maintained.

Comments?  If my thinking is appropriate, we could be saving a lot of 
unnecessary and expensive medicine use. One of our country's "experts" 
in osteoporosis seems to use this approach in some of his 
patients...that I am aware of.

Geraldine Bartlett
Pharmacist
South Africa
Email: bartlett@icon.co.za



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