594753 Last update: 2023-08-11
Biphosphonates Delusions

Discovered at the end of the 1960’s and initially called diphosphonates, the biphosphonates started to be seriously commercialized during the 1990’s.  Their mode of action is to inhibit osteoclasts, the bone cells whose mission it is to clean up the bone rendered useless (a little bit like old wood on a tree that needs to be trimmed). Their aim is to reinforce the bones, and their usage is increasing significantly.

Their main goal, which is logical, is to target the weaknesses of bone mass, which might typically be seen in: post-menopausal osteoporosis, ageing men, or as a consequence of prolonged use of artificial corticosteroids. Bisphosphonates specifically inhibit the osteoclasts that destroy bone, leaving the osteoblasts, the ‘heroes’, to build new bone. In the short-term, this allows the bone mass to increase, but only temporarily.

However after a few months, or years, of continued use the bone architecture loses its dynamic nature. It is now no longer able to continually adapt to the structural changes of the skeleton. Just look at the silhouette of individuals aged 50, 60, 70, 80 or 90 years old and you can almost guess their age by the outline of their figure.

It is not rocket science to realize that this bone, which is thicker, doesn’t adapt well to the new axes of pressure resulting from the changing skeletal architecture. While it is true the bone is without doubt more abundant, in reality it is also more fragile, and…has even been known to break spontaneously!

I know that this sounds unbelievable but more and more scientific studies are raising numerous concerns about these drugs, including: inadequate bone mass of the femur, atypical sub-trochanteric fractures, osteonecrosis of the jaw, and failure of dental implants. All of these have been highlighted in recently published medical journals.

One even finds a much higher complication rate in the orthopedic repairs of these “atypical” femur fractures. Of yet more concern, many fractures happen during surgical interventions or in its aftermath around the fixing plates; and that is not such a good thing!  It is also not reassuring that many dentists, who specialize in dental implants, categorically refuse to operate on patients treated with bisphosphonates!

Finally, to close this first section on the side-effects of bisphosphonates, one must underline the fact that the longer these drugs are taken, the more frequent the occurrence of the atypical fractures. It is also useful to understand that the side-effects can even impact the eye socket and digestive tract.

It appears that there is a risk of developing an eye inflammation such as uveitis where the scleritis increases by 50%, even if the risk remains statistically low. The irritation of the esophagus frequently experienced after taking bisphosphonates (for which instructions for its use are well documented: fasting and standing) appears to increase the risk of cancer of the esophagus, albeit that this remains a controversy (as too the atrial fibrillation, a form of cardiac arrhythmia, which is apparently more frequent also).

All of the above are the subject of scientific publications that I invite you to discover on my website www.gmouton.com, in the heading “articles” under the title “7h- The Bisphosphonates Delusion”. This article, in English, deals with this subject and is rigorously referenced with 14 publications all dated 2010-2012.

So what conclusions should we draw regarding the utilization of bisphosphonates?  The precise directions for their usage, and the length of time taking them, should be re-examined in view of the new data that is emerging. In the case of a recently menopausal woman that is suffering from osteopenia (a precursor stage of osteoporosis) is it really foolproof to take bisphosphonates that will increase her bone density during her fifties but will make them fragile for decades to come, precisely when the risk of fracture becomes more and more significant? I will let you answer that question….

By changing nothing, we hang to what we understand, even if it is the bars of our own jail.
- John le Carré, The Russia House 1989

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