Polio Survivors and Osteoporosis
Question: I have both osteoporosis and acid reflux. I just read that the anti-reflux drug I'm taking may cause my bones to get thinner. I already am taking Fosamax, which I also read can cause my jawbone to die! Should I stop both these pills?
Answer: I’ve received MANY emails about Osteoporosis.
Polio survivors are finding themselves between drugs and a soft place, that soft place being their bones. Osteonecrosis -- bone death – was reported in the jaws of 63 patients taking bisphosphonates, drugs that are given to increase bone density. Fifty-seven patients received intravenous bisphosphonates as treatment for cancer. But, six took Fosamax, the well-known oral anti-osteoporosis medication. Dentists across the country have reported about fifty cases of jaw osteonecrosis. Given that about three million women take Fosamax, fifty is a small number of cases. Even if you assume that only about one percent of problems caused by a given medication are reported, jaw osteonecrosis would occur in only two-tenths of one percent of women taking Fosamax. Still, if it's your jaw that's dying, who cares about percentages? So, the FDA now wants labels on all bisphosphonates to warn about the possibility of osteonecrosis.
If drugs to treat osteoporosis aren't causing enough worry, in late 2006 a study of nearly 150,000 people over 50 year-old found that taking proton pump inhibitors (anti-acid reflux drugs like Nexium) for more than a year increased their risk of a hip fracture by 44 percent. The higher the dose and the longer the drugs were taken, the risk of a hip fracture, especially among men, rose nearly 200 percent. The increased risk of fracture may be caused by proton pump inhibitors interfering with your body’s ability to deposit calcium inside your bones to increase their strength. This unfortunate side effect of proton pump inhibitors is a two-headed dragon for polio survivors.
The first is that polio survivors with paralysis, both female and male, have osteoporosis more frequently because they either haven't been “pushing” on their bones by standing on their legs (the result of using a weight-bearing brace, crutches or a wheelchair) or because their weak or paralyzed muscles haven't been “pulling" on bones. It's the pushing and pulling that makes calcium bind inside bones so they won't become brittle.
The second is that our 1985 Post-Polio Survey found that gut problems, including ulcers and acid reflux, are between six and fifteen times more common in polio survivors than in the general population. To make things worse, sleep apnea, which we have found in 25% of Post-Polio Institute patients, may increase reflux.
Oh, and another "head" has just reared its ugly self. A 2007 study of 5,000 adults 50 year-old and older found that daily use of the newer antidepressant medications (selective serotonin reuptake inhibitors -- SSRIs -- like Prozac) decreased bone density by as much as four percent and doubled the chance of breaking a bone. What's more, the higher the dose of an SSRI, the risk of falling increased by fifty percent.
So, what's to be done about your belly, your brain and your bones? All female polio survivors, and males who have muscle weakness or paralysis, should have a DEXA bone density scan to determine if they have osteoporosis or osteopenia, a lesser decrease in bone density that still increases your risk of fracture.
If you have decreased bone density, ask your doctor if you could try to increase calcium, vitamin D and protein before starting a bisphosphonate. If you need medication, ask about using calcitonin, a hormone that also increases calcium inside your bones, or the non-bisphosphonate drug Evista.
If you are taking a proton pump inhibitor or an SSRI, ask your doctor if increasing calcium would be helpful in combating these drugs' unwanted effects on bone density and falling.
And, postmenopausal women should talk to their gynecologist about whether hormone replacement is an appropriate treatment.
Unfortunately, fatiguing exercise or walking to "push and pull" on bones is not a treatment for osteoporosis or osteopenia in polio survivors, since exercise can cause muscle weakness and exactly what you're trying to prevent: a fall and a fracture.