Your Drug May
Be The Problem. Are You Taking A Bad Drug?
Chapter 34. Fosamax
Induced Bilateral Femur Fractures
I received this letter from a lady who suffered
bilateral mid-femur fractures after ten years of taking the anti-osteoporosis
drug, Fosamax™ (Alendronate):
Dear Dr. Dach,
I am a femur-fracture
survivor...bilateral. The right leg broke in March, the left one in July,
2009. I also suffered a compression fracture at L1 in May.
I was given Fosamax™ 10 years ago as a
preventive measure. Now I am worse than I would have been 20 years down the
road. I cannot begin to tell you that there are women breaking a leg
everyday! And they do not know why. It was through the fact, that the
orthopedic doctor who took my emergency case on the first leg, had just
received some information about the bilateral fractures. If you held my x-ray
up against several other women’s, you could not tell us apart!
I hope you continue to write and
correspond about this important subject. My life has been taken away from me
in a way that I never dreamed would happen.
Thank You, VS.
My Reply to VS – These Are Bad Drugs
coming forward to share your story of Fosamax induced Femur Fractures. As you
know, this type of fracture is very unusual, and only occurs in abnormal
bone. This is called "pathological
fracture" and is caused by change in bone quality induced by Fosamax™. These pathological mid femur fractures heal
very poorly even with the best of treatment.
Fosamax™, Actonel™, Boniva™ and all the bisphosphonates work by
killing the osteoclast bone cells.
This creates pathologic abnormalities in bone architecture that leads
to increased bone density on the DEXA scan.
Paradoxically, this dense bone is weaker, brittle and prone to
pathological fracture at the mid-shaft level of the femur. A fracture at this mid -femur location is
highly characteristic of a Fosamax induced fracture. We have been hoodwinked
by the Sally Fields Television ads and deceitful marketing campaigns. These are bad drugs. I predict that
as mid-femur pathologic fractures become more common, people will start to
wake up, and eventually these drugs will be banned. VS, I am very sorry that
this happened, and hopefully your efforts will educate others about this
Jeffrey Dach MD
of Spontaneous Mid Femur Fracture on Fosamax
Clarita Odvina MD reported nine cases of spontaneous
femur fracture on Fosamax™ (Alendronate). (2) Dr. Goh, a doctor in Singapore, identified
nine more cases in his 2007 report of subtrochanteric femur fractures with
minimal trauma in women on long term Fosamax. (3) Joseph M Lane MD reported 15
cases of spontaneous femur fracture in women on Fosamax (Alendronate). His report appeared in the New England
Journal March 20, 2008. (4) Dr. Lane found that "ten of the 15 patients were found to share a
unique radiographic pattern, defined
as a simple transverse or oblique (30°) fracture with beaking of the cortex and
diffuse cortical thickening of the proximal femoral shaft." (4)
Case Reports from Jennifer Schneider MD
These additional case reports were published in 2009
Geriatrics by Jennifer Schneider MD (1):
“A 66-year old, previously healthy
woman developed a spontaneous stress fracture of her right foot, which
eventually healed. Nine months later she took a step in her bedroom and
collapsed to the floor. An x-ray revealed a nontraumatic fracture of her
right femur. She underwent surgery with placement of an intramedullary rod.
Her physician told her she had most likely had a stress fracture, which
became a completed fracture. A bone scan done shortly after her surgery
revealed a stress fracture of her left femur. Some months later she underwent
prophylactic rodding of the left femur. The patient had been on alendronate
for 7 years.
A 65-year woman visiting Europe
stepped off the bottom step of a van and collapsed. An x-ray revealed a
nontraumatic fracture of her left femur. She had been experiencing a dull
ache in her left femur for some months. The patient underwent placement of an
intramedullary rod. One year later she developed a dull ache in her right
femur. A bone scan showed a stress fracture in the right femur. A bone
specialist recommended prophylactic rodding of the right femur, which was
done. The patient had been on alendronate for 9 years.
A 59-year-old-woman took a step, her
right leg gave out, and she fell to the ground as she heard her leg break.
Her femur was fractured. The orthopedic surgeon on call told her, “We don’t
usually see this type of fracture without trauma.” For the preceding year
she’d experienced pain in her right thigh, which was severe enough to cause
limping. An x-ray had been negative, and her primary care physician thought
she had fibromyalgia. She had been on alendronate for more than 5 years.”endquote
Dr Jennifer Schneider . (1)
Companies Fight Back Attempting to Exonerate Fosamax
The drug companies are aware of this problem, and
are fighting back by paying doctors to deny the link between fosamax and
pathological fracture of the femur. An
example is this study of the Danish National Bone Registry: (6)
is Rotten in Denmark"
The title is : Subtrochanteric and Diaphyseal Femur
Fractures in Patients Treated With Alendronate: A Register-Based National
Cohort Study by Bo Abrahamsen in the June
2009 Journal of Bone and Mineral Research.
The author says, "Recent
reports have found long-term Alendronate use to be common in patients with
subtrochanteric or proximal diaphyseal femur fracture, raising concerns that
these fractures could be a consequence of excessive suppression of bone
Doubles the Risk of Subtrochanteric Fracture
Even though the Danish Registry data actually showed
the Fosamax™ (alendronate) group had an increased incidence of subtrochanteric
fractures (2.9 vs. 1.6 per 1000 patient years), nonetheless, Dr. Bo Abrahamsen
concluded the cause was osteoporosis and NOT
the Drug !! Here is the author’s conclusion: "Subtrochanteric/diaphyseal femur fractures ... are best
classified as osteoporotic fractures."
In my opinion, this conclusion is not only wrong, it is blatantly wrong.
These mid-femur fractures are NOT osteoporotic fractures. This is blatantly obvious. I will explain why below.
On Drug Company Pay Roll
Here is a list of author's competing interests:
Dr. Abrahamsen receives consultancy
fees from Nycomed and Novartis, research grants from Roche, and speaker's
fees from Servier, Eli Lilly, and MSD. Dr. Eiken receives speaker fees from
Nycomed, Roche, and Servier. Dr. Eastell receives research funding or
consultation honoraria from Amgen, AstraZeneca, Aventis, Eli Lilly, GlaxoSmithKline,
Hologic, Interleukin Genetics, Kyphon, Lilly, Maxygen, Nastech
Pharmaceuticals, Nestle Research Center, New Zealand Milk Limited, Novartis,
Novo-Nordisk, Ono Pharma, Organon, Osteologix, Paraxel, Pfizer, Procter &
Gamble, Roche Diagnostics, Sanofi-aventis, Servier, Shire, Transpharma
Medical Limited, Unilever, and Unipath.
Induced Fractures have a UNIQUE Radiographic Appearance
Joseph M Lane MD reported a unique radiographic
pattern of these Fosamax induced fractures.(4) This means these spontaneous mid-femur
fractures are pathological fractures induced by the drug, and virtually NEVER happen unless the patient is on a
bisphosphonate drug like Fosamax™.
Anatomy Dictates that the Femoral Neck Will Fracture First
Osteoporotic fractures present most commonly as
compression fractures of the vertebral bodies, or as femoral neck
fractures. Even in cases of severe
osteoporosis, the femur never spontaneously fractures at the mid femur level
simply because the anatomy dictates that the femoral neck will fracture
first. I have known this from personal
experience as a radiologist for thirty years reading X-Rays of fracture
cases. A spontaneous mid-femur fracture
is extremely rare and indicates a pathologic fracture caused by a drug or
Same Unique Pattern As Rare Genetic Bone Disease of Toulouse Lautrec
Left Image: Henri de Toulouse-Lautrec, one
of the greatest painters of the Post-Impressionist period. 1864- 1901. Note short stature caused by spontaneous
bilateral mid-femur fractures as a child from genetic bone disease called
Another important observation is the similarity
between Fosamax™ induced femur fractures and a rare genetic bone disease,
Pycnodysostosis, also called Toulouse Lautrec's Disease.(7-8) This genetic disease causes malfunctioning
osteoclasts, the same mode of action of the drug, Fosamax™. The famous French Impressionist artist, Toulouse
Lautrec suffered bilateral femur fractures as a child which never healed
properly resulting in short stature, as shown in old photographs.(8) Lautrec's femur fractures had the same unique
radiographic appearance described by Dr Joseph Lane for Fosamax™ induced femur
Fosamax™ induced mid-femur fractures have a unique radiographic appearance, and
share this unique appearance with a rare genetic bone disease (Toulouse Lautrec's
Disease). Therefore, these mid-femur
fractures are not typical osteoporotic fractures, they are a distinct form of
pathologic fracture induced by the drugs, Fosamax, Actonel and Boniva. These are “Bad Drugs” that should be banned
or severely curtailed.
References for Chapter 34.
Fosamax™ Induced Femur Fractures
(1) http://www.jenniferschneider.com/articles/Bisphosphonates.pdf Bisphosphonates and low-impact
femoral fractures: Current evidence on alendronate-fracture risk by Jennifer P.
Schneider, MD, PhD. Geriatrics.2009;64(1):18-23.
(2) http://jcem.endojournals.org/cgi/content/full/90/3/1294 The Journal of Clinical
Endocrinology & Metabolism Vol. 90, No. 3 1294-1301 Severely Suppressed
Bone Turnover: A Potential Complication of Alendronate Therapy Clarita V. Odvina, Joseph E. Zerwekh, D.
Sudhaker Rao, Naim Maalouf, Frank A. Gottschalk and Charles Y. C. Pak
(3) http://www.jbjs.org.uk/cgi/content/abstract/89-B/3/349 Journal of Bone and Joint
Surgery - British Volume, Vol 89-B, Issue 3, 349-353. Subtrochanteric insufficiency fractures in
patients on alendronate therapy A
CAUTION, S.-K. Goh et al.
(4) http://content.nejm.org/cgi/content/full/358/12/1304 NEJM Volume 358:1304-1306
March 20, 2008 Number 12. Atypical Fractures of the Femoral Diaphysis in
Postmenopausal Women Taking Alendronate Brett A. Lenart, B.S. Dean G. Lorich,
M.D. Joseph M. Lane, M.D. Weill Cornell Medical College New York, NY
Exonerated in 'Atypical' Femoral Fractures By Michael Smith, North American
Correspondent, MedPage Today. September 15, 2008 Reviewed by Robert
Jasmer, MD; Associate Clinical Professor of Medicine, University of California,
San Francisco .
J BMR, Volume 24, Number 6, 2009, Subtrochanteric and Diaphyseal Femur
Fractures in Patients Treated With Alendronate: A Register-Based National
Cohort Study Bo Abrahamsen,1 Pia Eiken,2 and Richard Eastell
Pycnodysostosis: Toulouse-Lautrec's and Aesop's disease? By Christos S.
Bartsocas. HORMONES 2002, 1(4):260-262
(8) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1811887/?tool=pubmed Proc R Soc Med. 1970 Aug; 63(8):800-5.Toulouse-Lautrec--triumph
over infirmity. Cawthorne T.
Author: Dr Dach
Jeffrey Dach MD