To pill or not to pill.

• Author: Klebanow, Diana
• Position: Risks and benefits of bisphosphonates as osteoporosis drug - Medicine & Health

"It almost seemed as if my femur had broken before I hit the floor [but] I had no reason to believe that the sudden collapse of my leg was related in any way to the [bisphosphonates] I had taken for osteoporosis. "

IN THE BOOK How Doctors Think, Jerome Groopman, a physician and professor of medicine at Harvard University, relates the story of a family member of one of his colleagues who had been advised against taking an osteoporosis drug by her internist. Although this patient was in her 70s and faced a higher risk of fractures because her bone density was at the lower limit of normal, her internist based his recommendation on the fact that the drug had been known to cause jawbones to break down in a small number of patients. Deciding to probe further, Groopman consulted with another colleague who was a specialist in bone metabolism, who disagreed with the internist's recommendation on the grounds that the benefits of this drug outweighed the risks: it was important to increase her bone density to decrease the risk of a fracture.

Grooprnan uses this story to illustrate the point that physicians sometimes pay too much attention to the potential risks of a drug and ignore the benefits. It was of particular interest to me because I had taken this same osteoporosis drug over a period of time. Although my jawbone did not collapse, I did fracture my femur (the thighbone that connects to the hip) while on this drug. In my case, the benefits of the drug did not outweigh the risks, and I later would be included in a study concerning the link between the drug and fractures of the femur.

A diagnosis of osteoporosis--the condition characterized by the loss of bone density, leading to an increased risk of bone fractures--certainly should be taken seriously, as it afflicts an estimated 10,000,000 Americans. Of these, 1,500,000 develop life-threatening fractures each year. Approximately 20% die from complications within a year, and an estimated 60% of those patients who survive only enjoy a partial recovery. While osteoporosis sometimes is regarded as a condition afflicting postmenopausal women--who may lose as much as 25% of their bone mass five years after menopause--about 20% of those who have it are male. Their risk is lower because they have a higher hone mass than females.

Osteoporosis certainly is not a new condition, and archaeologists even have detected one of the easily identifiable signs of it--a spinal hump-in Egyptian mummies. The leading cause is the lack of certain hormones, particularly estrogen in women and androgen in men. During the course of a life cycle, bone constantly is being rebuilt (or remodeled)...