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Ask the Pharmacist

Should I Keep Taking Fosamax for My Osteoporosis?

Carefully weigh the known risks of bisphosphonate drugs against their potential benefits

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Long-term use of many drugs, for example, can cause bone loss, including some that are commonly prescribed to older adults. Among them: steroids, which are used to treat a variety of inflammatory diseases and conditions; short-acting loop diuretics, which are typically prescribed to treat hypertension (high blood pressure) and edema (fluid retention); and proton pump inhibitors, such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), and pantoprazole (Protonix), which are typically used to treat the symptoms of gastroesophageal reflux disease (GERD).

I also recommend that you read a report of the Surgeon General of the United States (it's a free download) on the best ways to promote bone health and prevent osteoporosis and fracture, which is the goal that I always focus on with my patients. The main approaches:

Diet. Make sure that you're giving your bones the best chance to stay strong by getting enough calcium (older people should take a calcium citrate — not calcium carbonate — supplement), vitamin D and other bone-building nutrients.

Exercise. Make sure that you're exercising regularly. Weight-bearing exercise — walking, jogging or anything else you can do on your feet — is best. Be sure to consult your doctor before starting a new exercise regimen.

Reduce your risk of falls and fractures. It's important to remember that falls — which play a role in approximately 90 percent of all hip fractures — are what you should really be worrying about.

So I advise my patients to take some simple, common-sense precautions at home to reduce their risk of a bone-fracturing incident: things like getting rid of throw rugs, adding some motion-activated lighting (especially in and around the bathrooms and stairs) and so forth.

I also pay special attention to medications that may adversely affect balance and stability (including benzodiazepines, antihistamines, antidepressants and antipsychotics).

As the old saying goes, an ounce of prevention is worth a pound of cure.

Ask the Pharmacist is written by Armon B. Neel Jr., PharmD, CGP, in collaboration with journalist Bill Hogan. They are coauthors of Are Your Prescriptions Killing You?, which was published in July by Atria Books.

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