Recent reports of severe pain and jaw osteonecrosis with these drugs are ”disturbing”, announced one journal recently (Med Lett Drugs Ther, 2005; 47: 33-5). Concerns have also been raised as to the possibility that long-term alendronate therapy suppresses bone turnover to such an extent that non-spinal bone fractures are more likely to occur and less likely to heal (J Clin Endocrinol Metab, 2005; 90: 1294-301).

Calcitonin is a naturally occurring hormone that is safer than oestrogen therapy (now that hormone replacement therapy has been discredited), demonstrating marked improvements in bone density (though the increases are not as great as with bisphosphonates). Injectable calcitonin can cause flushing, nausea and pain at the injection site. However, in its newer (and more tolerable) form - a nasal spray - it reduces fractures in the lumbar spine, but not in the hip (Pharmacotherapy, 2005; 25: 574-84).

Raloxifene, a second-generation non-steroidal (non-hormonal) drug, was developed to offer postmenopausal women the advantages of oestrogen therapy while avoiding its major side-effects. One study showed that raloxifene decreases the risk of non-vertebral fracture, but only in women who already have spinal fractures (Pharmacotherapy, 2005; 25: 574-84). However, another study showed no effects of the drug on non-spinal fractures in postmenopausal women after eight years of treatment (J Bone Miner Res, 2005; 20: 1514-24). It’s also associated with hot flushes, leg cramps and deep vein thrombosis (J Musculoskelet Neuronal Interact, 2000; 1: 127-32; Clin Calcium, 2004; 14: 100-4).

Kim Wallace