mmatw...
There are more studies available that support the use of
Fosamax than studies to support the contentions of the
site you cited. Additionally, I am natively inclined to find
solutions which leave medications as a last resort.
But it's my job to provide objective information,
So let's take this step by step.
This page, from Doctor's Guide Publishing Limited,
cites a study, led by University of Iowa researchers,
in which Fosamax was tested on patients who were taking
prednisone and experiencing osteoarthritis:
"Research Finds Effective Treatment For Steroid-Induced Osteoporosis"
"IOWA CITY, IA -- July 29, 1998 -- Researchers report in tomorrow's
issue
of The New England Journal of Medicine that Merck & Co's Fosamax
(alendronate) may help prevent and treat steroid-induced
osteoporosis."
"University of Iowa researchers, led by Kenneth Saag, M.D., assistant
professor of internal medicine, and investigators from 14 other U.S.
and 22 international sites, detail the results of two 48-week studies
of 477 men and women ages 17 to 83 receiving 7.5 mg or greater of
prednisone (or equivalent) daily. The studies examined the
effectiveness of alendronate in preventing and treating osteoporosis
among patients undergoing steroid therapy."
"'Steroids such as prednisone are often prescribed by doctors for a
number of medical conditions, including rheumatoid arthritis,
asthma and inflammatory bowel disease,' Saag said. 'While
steroids are effective in treating these diseases, osteoporosis is
often an unavoidable, yet serious, long-term side effect.'"
"Patients in the studies received either an oral dose of alendronate
(5 mg to 10 mg) or an inactive placebo. All the patients also were
given calcium (800 mg to 1,000 mg) and vitamin D supplements
(250 to 500 IU), which are currently recommended for preventing
and treating steroid-induced osteoporosis."
"The researchers found that either dose of alendronate, added to
calcium and vitamin D, significantly increased bone mineral
density (BMD) -- the most important predictor of fracture risk --
at the spine and hip in men and women taking steroids compared
with placebo (calcium and vitamin D). The results were consistent,
regardless of the patient’s age, gender, underlying disease, dosage
or length of time on steroid therapy."
Increase in spine BMD was highest in post-menopausal women
not taking estrogen who received 10 mg of alendronate, the
researchers said. Post-menopausal women taking steroid
treatments are among those at the highest risk for steroid-induced
osteoporosis, due to the combined detrimental effects of estrogen
deficiency and steroids on their bones."
"The studies also showed fewer patients on alendronate had spine
fractures compared with those patients on placebo."
"Researchers already knew that alendronate could prevent and treat
postmenopausal osteoporosis and prevent fractures, but the new
study findings show that the drug can also play a role in preventing
and treating osteoporosis caused by steroids, Saag explained."
"Of the 30 million American men and women who have diseases
that may require treatment with glucocorticoid steroids, an
estimated one million people presently use them on a chronic basis."
"'Early intervention is critical because steroid users lose large
amounts of bone and lose it rapidly-as much as 10 to 20 percent
in the first year of steroid treatment," Saag said. "Approximately
50 percent of chronic steroid users develop osteoporosis,
increasing their risk for fractures. Calcium and vitamin D
supplements, hormone replacement therapy and exercise
have been the recommended modes of therapy, but our
studies show that alendronate provides additional benefit over
and above calcium plus vitamin D.'"
"In the studies, alendronate at 5 and 10 mg was generally
well tolerated. Esophageal adverse experiences were not
increased with alendronate treatment, nor were peptic
ulcers despite concurrent use of steroids in all patients
and extensive use of aspirin, non-steroidal anti-inflammatories
and slow-acting anti-rheumatic drugs."
"Fosamax is indicated in the U.S. for the treatment and
prevention of post-menopausal osteoporosis and for the
treatment of Paget’s disease of bone."
http://www.pslgroup.com/dg/91106.htm
Google's cache of the Merck Manual site's page on 'prescribing
information' for Fosamax also notes that
calcium and vitamin D should be supplemented while
taking Fosamax:
"Hypocalcemia must be corrected before initiating therapy
with FOSAMAX (see CONTRAINDICATIONS). Other
disturbances of mineral metabolism (such as vitamin D
deficiency) should also be effectively treated. Presumably
due to the effects of FOSAMAX on increasing bone mineral,
small, asymptomatic decreases in serum calcium and
phosphate may occur, especially in patients with Paget’s
disease, in whom the pretreatment rate of bone turnover
may be greatly elevated and in patients receiving
glucocorticoids, in whom calcium absorption may be
decreased."
and, regarding its efficacy:
"The efficacy of FOSAMAX for the treatment of
glucocorticoid-induced osteoporosis has been shown in
patients with a median bone mineral density which was
1.2 standard deviations below the mean for healthy young
adults."
"The efficacy of FOSAMAX has been established in studies
of two years’ duration. The greatest increase in bone mineral
density occurred in the first year with maintenance or smaller
gains during the second year. Efficacy of FOSAMAX beyond
two years has not been studied."
"The efficacy of FOSAMAX in respect to fracture prevention
has been demonstrated for vertebral fractures. However,
this finding was based on very few fractures that occurred
primarily in postmenopausal women. The efficacy for
prevention of non-vertebral fractures has not been
demonstrated."
"Ensuring adequate calcium and vitamin D intake is especially
important in patients with Paget’s disease of bone and in
patients receiving glucocorticoids."
http://216.239.53.100/search?q=cache:oNh79wVW3bcC:www.merck.com/product/usa/fosamax/cns/product_info/pi/pi_precautions.html+fosamax+osteoporosis+studies&hl=en&ie=UTF-8
PubMed, an archive and search service of the National
Library of Medicine, allows searches on medical issues.
I ran searches for "Fosamax and density", and 312
results were returned. You can view the search results
at the following link. I found none that failed to
substantiate the increase in Bone Mineral Density in
their outcomes:
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=4&term=fosamax+density&dopt=b&dispmax=100&tool=EntrezLinkDoc
Another search at PubMed, for "'Fosamax and 'bone strength'" turned up
a study in rats which measured, not only bone density,
but bone STRENGTH, as measured by "biomechanical testing"
of the bone strength in 3 locations. The results indicated increased
strength, as well as mass, with the use of Fosamax. This would
seem to contradict your website's contention, though this study
was short term, being for 28 days. The study was done by
Mosekilde L, Thomsen JS, Mackey MS, Phipps RJ., at the
Department of Cell Biology, Institute of Anatomy, University
of Arhus, Arhus, Denmark.:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11062350&dopt=Abstract
There are other such studies available for your study.
Simply enter [Fosamax "bone strength"], without the
brackets, in this page's search window:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=PubMed
I suspect that there is truth to the value of both of the approaches
being considered. There is certainly wisdom in utilizing diet and
exercise to improve bone health. And there are situations in which
a person's condition will be too far progressed for those approaches.
And while I was researching, it occured to me that the issue of
loss of bone density is one of the major concerns of NASA, in
regard to the astronauts spending extended periods in zero
gravity, which rapidly depletes bone mass. This would seem to
make it obvious that, if gravity can 'maintain' bone mass, then
weight-lifting can increase it, which NASA found to be the case.
So I thought I'd check on their latest information regarding the
issue of maintaining bone density, and found something very
interesting at the Cosmiverse website, Source: Science@NASA
Cosmiverse Staff Writer:
"Vibrations May Help Reduce Astronaut Bone Loss"
November 5, 2001 07:00 CDT
"Scientists working with the effects of weightlessness on
humans in space have developed a theory that vibration
therapy might reduce the amount of bone mass loss in
astronauts. While exercising has helped reduce muscle
atrophy in space, loss of bone mass has remained a
problem."
"Astronauts in space often spend hours each day working
out with the aid of exercise apparatus. Unfortunately, such
countermeasures have not solved the problem of bone loss.
Even as astronauts work out, their skeletons continue to
weaken slowly. It's been a thorny problem for researchers."
"But now, perhaps, there could be a solution: NASA-funded
scientists suggest astronauts might prevent bone loss by
standing on a lightly vibrating plate for 10 to 20 minutes each
day. Held down with the aid of elastic straps, the astronauts
could keep working on other tasks while they vibrate."
"Right: Plenty of exercise is a key to maintaining muscles
and cardiovascular fitness in space. But such workouts
haven't solved the problem of bone loss."
"The same therapy, they say, might eventually be used to
treat some of the millions of people who suffer from bone
loss, called osteoporosis, here on Earth."
"'The vibrations are very slight,' notes Stefan Judex,
assistant professor of biomedical engineering at the State
University of New York at Stony Brook, who worked on
the research. The plate vibrates at 90 Hz (1 Hz = 1 cycle
per second), with each brief oscillation imparting
acceleration equivalent to one-third of Earth's gravity.
"'If you touch the plate with your finger, you can feel a very
slight vibration,' he added. 'If you watch the plate, you
cannot see any vibration at all.'"
"Although the vibrations are subtle they have had a profound
effect on bone loss in laboratory animals such as turkeys,
sheep and rats. "
"In one study (published in the October 2001 issue of The
FASEB Journal), only 10 minutes per day of vibration
therapy promoted near-normal rates of bone formation
in rats that were prevented from bearing weight on their
hind limbs during the rest of the day. Another group of
rats that had their hind legs suspended all day exhibited
severely depressed bone formation rates -- down by 92%
-- while rats that spent 10 minutes per day bearing weight,
but without the vibration treatment, still had reduced bone
formation -- 61% less."
"These results show that the vibration treatment kept the
bones healthy, while brief weight bearing did not."
http://www.cosmiverse.com/space11050101.html
There's more to the article at the link above.
And, to support my statements regarding weight-lifting
as a preventative for osteoporosis, the following page
from HealthWho.com, cites the NIH, or National
Institutes of Health:
"Strength training, like lifting weights or exercising against
resistance, can make bones stronger, improve balance,
and increase muscle strength and mass. This can prevent
or slow bone-weakening osteoporosis, and may lower the
risk of falls, which can cause hip fractures or other injures."
Read the entire page, here:
http://www.healthwho.com/health_edu/seniors/seniors_Apr_004.cfm
In summarizing, my research has suggested to me that
diet and exercise are the best preventive measures, with
an emphasis on weight-lifting and weight-bearing forms.
However there are situations in which medication may be
needed to supplement these measures, and Fosamax
seems to do the job, especially in conjunction with calcium
and vitamin D. And it wouldn't hurt, apparently, to find a
vibrating platform to stand on.......maybe the washing
machine?
Searches done, via Google:
fosamax osteoporosis studies
://www.google.com/search?hl=en&ie=UTF-8&oe=UTF-8&q=fosamax+osteoporosis+studies
NASA astronaut bone density treatment
://www.google.com/search?num=50&hl=en&lr=&ie=UTF-8&oe=UTF-8&q=NASA+astronaut+bone+density+treatment
weight-lifting seniors "bone loss"
://www.google.com/search?hl=en&ie=UTF-8&oe=UTF-8&q=weight-lifting+seniors+%22bone+loss%22
Searches done on MedLine:
fosamax density
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=4&term=fosamax+density&dopt=b&dispmax=100&tool=EntrezLinkDoc
fosamax "bone strength"
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=PubMed
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