Alert! Never-Published Study Uncovers How And Why Bisphosphonates Cause Atypical Fractures - Save Our Bones

By Vivian Goldschmidt, MA

Alert! Never-Published Study Uncovers How And Why Bisphosphonates Cause Atypical Fractures

A recent University of Michigan study has revealed ground-breaking news about the bone-destroying nature of bisphosphonates, the most commonly prescribed class of osteoporosis drugs. The research uncovers the mechanism by which bisphosphonates weaken the femoral neck, leading to atypical femur fractures.

Why isn’t this news being shouted from the rooftops? Shamefully, this study was covered up, never published in any of the major journals, and only revealed within the confines of the Orthopedic Research Society’s 2013 meeting.

Today, we’re going to analyze what the study reveals, and why it was covered up.

Atypical Femur Fractures: A Closer Look

An atypical femoral fracture is just that – not typical. It’s an unusual type of fracture that is characterized by the following features:

  • Lack of traumatic injury (atypical fractures are spontaneous)
  • Pain in the groin or thigh preceding the fracture
  • Fracture is located in the femoral shaft or “subtrochanteric” (below the trochanter of the thigh bone)
  • Cortical thickening
  • Fracture is transverse, short oblique, or noncomminuted (typical femur fractures are spiral, comminuted, and other forms)
  • Delayed healing
  • History of bisphosphonate use1

This last point is notable – a history of bisphosphonate use is included in the official characteristics that define an atypical femur fracture.

The Connection Between Bisphosphonates And Femoral Fractures

For years, researchers have been exploring the apparent connection between long-term bisphosphonate use and the occurrence of atypical femoral fractures.

In 2010, a task force reported that:

“
recent observations suggest that the risk [of atypical femoral fractures] rises with increasing duration of exposure, and there is concern that lack of awareness and underreporting may mask the true incidence of the problem.”2

And a 2012 study entitled, “Increasing Occurrence of Atypical Femoral Fractures Associated With Bisphosphonate Use” begins with this background statement:

“Current evidence suggests that there is an association between bisphosphonate therapy and atypical femoral fractures, but the extent of this risk remains unclear.”3

The study, which was published in the prestigious Archives of Internal Medicine Journal, which forms part of the JAMA network, concludes that:

“Atypical femoral fractures were associated with bisphosphonate use; longer duration of treatment resulted in augmented risk. The incidence of atypical fractures increased over a 12-year period, but the absolute number of such fractures is very small.”3

Notice the caveat that the “absolute number” of such fractures is small, which deflects from the point entirely. The point is that drugs intended to make bones stronger have the opposite effect, and the longer they are used, the greater the chance that those deleterious effects will actualize.

Another comprehensive review of atypical femoral fractures noted that:

“
current epidemiologic evidence suggests that long-term bisphosphonate use may be an important risk factor for atypical fractures. Long-term bisphosphonate users must be monitored for biochemical markers of bone turnover and evidence of stress fractures in the proximal femur.”1

While this report gets closer to directly implicating bisphosphonate use with atypical femoral fractures, like other studies, reviews, and reports, the information remains vague, sprinkled with caveats like the one above, or language about how bisphosphonate use “has been shown to increase bone mineral density and to reduce
fracture risk.”3

All of these studies failed to uncover the mechanism by which bisphosphonates set the stage for fractures. Even more disturbing, some research ignores what should be a logical conclusion, deflecting the direction of the evidence away from the mechanism by which bisphosphonates increase fracture risk.

For example, a meta-analysis, first published online in 2014, that explored the “increasing occurrence of atypical femoral fractures associated with bisphosphonate use” lays out the mechanism by which alendronate (Fosamax) “works”:

“ALN [alendronate] belongs to the third generation of bisphosphonate drugs that could inhibit the activity of osteoclasts by physicochemically combining with the bone matrix and subsequently blocking the action of osteoclasts by inducing the secretion of a variety of cytokines.”4

Taken to its logical conclusion, and coupled with a rudimentary understanding of how natural bone remodeling works, one can easily see how this cellular manipulation could result in weakened bone and increased fracture risk. The analysis goes on to note that slightly more than 82% of atypical fracture sufferers had been treated with bisphosphonates, yet concludes that:

“
this meta-analysis suggests that patients undergoing long-term treatment using ALN may be at an increased risk of AFF [atypical femoral fractures].”4 (emphasis mine)

Incredible!

Vague language like this gives the Medical Establishment leeway to continue prescribing these drugs; after all, it’s easy to ignore inconclusive evidence and instead blame the patient’s genetics or other factors when atypical femur fractures occur during bisphosphonate therapy.

For instance, a recently-published Japanese study goes to great lengths to point out the characteristics of those who suffer atypical fractures of the femur. Despite language clearly implicating the mechanism by which bisphosphonates weaken bone, the researchers still side-stepped the obvious conclusion.

“A reduction of the bone turnover by BP [bisphosphonate] treatment alters the bone mineral and matrix properties
 BP therapy causes an increase in advanced glycation end products of the extracellular bone matrix, deteriorating the mechanical properties of the bone. 
Prolonged BP therapy causes the accumulation of microdamage to bone and reduces the heterogeneity of the organic matrix and mineral properties.”5

Despite this evidence, the study then devotes a significant segment to an analysis of “Femoral geometry and biomechanical considerations of the lower limb” as risk factors for atypical fractures.5 It’s always easier to blame the patient.
Nonetheless, despite excuses and vague language, it’s getting harder and harder to cover up the evidence and minimize the risk associated with bisphosphonates that these studies reveal. Hence the push for new osteoporosis drugs to replace bisphosphonates.

Finally, an unflinching study was discovered that doesn’t side-step obvious conclusions, but instead observed the action of bisphosphonates on bone on the cellular level.

Revealed: The Mechanism Behind Bisphosphonate-Induced Bone Weakness

That’s where the revealing University of Michigan study comes in. While other research has hinted at the possibility of bisphosphonates causing atypical femoral fractures, this study analyzed just how bisphosphonates weaken bones on a cellular level.

The researchers in this study set out to find “the association between bisphosphonate therapy and atypical, low-energy subtrochanteric femoral fractures.”6

Their hypothesis was that:

“
microcracks and their surrounding osteocyte lacunae are particularly prone to direct bisphosphonate binding.”6

Lacunae are small, round cavities in cortical bone formed during the resorption phase of bone remodeling. Within these cavities are osteocytes, which form into bone cells that correspond with the type of bone (cortical bone cells, for instance, are more elongated in shape than trabecular bone cells).

Osteocytes mature and differentiate into various forms, with some ending the bone remodeling cycle as osteoblasts (bone-building cells) that are incorporated into the bone matrix. It’s important to bear this in mind as we look at the following study.

Testing The Hypothesis

To test the hypothesis noted above (“microcracks and their surrounding osteocyte lacunae are particularly prone to direct bisphosphonate binding”), researchers studied the forearms of mice. After undergoing cyclic loading, the mice were given the bisphosphonate pamidronate, in the form of Osteosense (far-red fluorescent pamidronate, or FRFP). After 24 hours’ recovery, the mice were euthanized and the bone cells of their forearms analyzed, with particular attention paid to areas of microdamage.

They found that:

“
bisphosphonates may interfere with targeted microdamage repair directly by binding to microcrack surfaces and interfering with osteoclast repair at the site that needs it the most.”6 (emphasis mine)

What’s more, bisphosphonates were found to interfere with the body’s targeted bone repair indirectly by “surrounding osteocyte lacunae” and thus interfering with a specific signal, called the apoptotic signal, by which the body induces targeted remodeling.6

In other words, bisphosphonates directly inhibit the body’s process of repairing microdamage that occurs with normal bone remodeling and everyday movement and exercise.

This explains why the longer the bisphosphonate use, the greater the risk of atypical fractures – bisphosphonates allow bone-weakening microdamage to accumulate, unchecked by the body’s natural repair mechanisms.

Given the ground-breaking nature of this discovery, it would make sense for bisphosphonates to be pulled from the market. But instead, studies not-so-coincidentally published in 2013 recommend a “bisphosphonate drug holiday” and tailoring the duration of bisphosphonate treatment to the individual patient.7, 8

Meanwhile the University of Michigan study presented at the 2013 Orthopedic Research Society meeting has since remained within its own confines, unpublished by any major scientific or medical journal.

Why The Cover-Up?

The answer is that it all comes down to a disturbing collaboration between the Medical Establishment and Big Pharma
all in the interest of protecting the blockbuster drugs – and the billions of dollars they generate to Big Pharma. There are a few exceptions, but the vast majority of scientists are afraid to present research that might undermine Big Pharma’s massive profits.

The good news is such information is getting harder to cover up. While the Medical Establishment and Big Pharma continue their desperate search for a non-bisphosphonate alternative drug, here at the Save Institute, we’re continuing to do our part to inform and empower as many people as possible with the truth about osteoporosis drugs.

And the truth is that there are many evidence-backed reasons to avoid osteoporosis drugs. The Osteoporosis Reversal Program is a safe, drug-free alternative to increasing bone density and boosting the body’s natural bone repair, instead of impairing it as osteoporosis drugs do.

Stop Worrying About Your Bone Loss

Join thousands of Savers from around the world who have reversed or prevented their bone loss naturally and scientifically with the Osteoporosis Reversal Program.

Learn More Now →

The Program explains exactly which nutrients your bones need (Foundation Supplements) and the foods that contain them (Foundation Foods), and why. It also explains the importance of a pH-balanced diet, of exercise in maintaining and building bone, delves into the benefits of stress relief in rejuvenating bone, and much more.

As you can see, the Osteoporosis Reversal Program is a comprehensive lifestyle and nutritional plan to show you how to build your bones without dangerous and toxic osteoporosis drugs.

Now you have yet another weapon in your fight against osteoporosis: the truth!

Till next time,

References:

1 Donnelly, Eve, et al. “Atypical Femoral Fractures: Epidemiology, Etiology, and Patient Management.” Curr Opin Support Palliat Care. 6. 3. (2012): 348-354. Web. April 30, 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4556525/
2 Shane, E., et al. “Atypical subtrochanteric and diapheseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research.” J Bone Miner Res. 25. 11. (2010): 2267-94. Doi: 10.1002/jbmr.253. Web. April 30, 2016. https://www.ncbi.nlm.nih.gov/pubmed/20842676
3 Meier, Raphael, P.H., M.D., et al. “Increasinng Occurrence of Atypical Femoral Fractures Associated With Bisphosphonate Use.” Arch Intern Med. 172. 12. (2012): 930-936. Web. April 30, 2016. Web. https://archinte.jamanetwork.com/article.aspx?articleid=1160667
4 Liu, Lu, et al. “Association between alendronate and atypical femur fractures: a meta-analysis.” 4. Z. (2015): 58-64. Doi: 10.1530/EC-14-0120. Web. April 30, 2016. https://www.endocrineconnections.com/content/4/1/58.full
5 Saita, Yoshitomo, Ishijima, Mueaki, and Kaneko, Kazuo. “Atypical femoral fractures and bisphosphonate use: current evidence and clinical implications.” Ther Adv Chronic Dis. 6. 4. (2015): 185-193. Web. April 30, 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4480549/
6 Davis, M.S., et al. “Visualization of bisphosphonate binding to bone microcracks and surrounding osteocyte lacunae using near-infrared optical imaging.” University of Michigan. 2013. https://www.ors.org/Transactions/59/007/0042.html
7 Diab, D.L., et al. “Bisphosphonate drug holiday: who, when and how long.” Ther Adv Musculoskelet Dis. 2013 Jun; 5(3): 107–111. doi:  10.1177/1759720X13477714
8 Ro, C. MD et al. “Bisphosphonate drug holiday: chosing appropriate candidates.” Curr Osteoporos Rep. 2013 Mar; 11(1): 45–51.doi:  10.1007/s11914-012-0129-9

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Comments on this article are closed.

  1. Nancy

    Hi Vivian, I have been diagnosed with osteoporosis due to leaking calcium into my urine. Idiopathic hypercalciuria. They put me on HCTZ which I was allergic to. Now they want to inject some bio phosphate into me. I said no. Do you have any experience with this or ant suggestions. Thank you!

  2. nancy casey

    To Pricilla Cunningham,
    I’m so sorry to hear of this horrible ordeal you are going through. They are trying to put my mom on fosomax now and I have a fight ahead of me. I have researched this topic at length and know thais is the wrong approach. A newsletter, called Health Alert, that I subscribe to and really respect is written by Dr. Bruce West. He heals people with supplements made from real live food, not synthetic drugs or vitamins. You might want to google him and read about his technique, you have nothing to lose and possibly a fun life again to regain. One of the latest issues talked all about bones and joints and pain and how he has something to help you. I’ve already ordered some for my mom. Good luck to you. It’s just sick that these drugs can do such damage, as you are experiencing and yet, still, they are prescribed and sold.

  3. Priscilla cunningham

    Sorry lot of typos meant on Boniva IV then finally Reclast shot destroyed my bones shattered femur and severe aim ever since Only help is dilaudid and flexirol dr lowered dose after 3 yrs and now life is terrible leg pains snd back deteriorating I’m scared Is there any hope for me I’m divorced and alone can’t pick up anything over 10 lbs used to model and have active life now Im afraid of more broken bones and also growths in gums from jaw Reclast destroyed
    Me I’m bedridden most of the time and feel useless hopeless All because of these drugs

    • Vivian Goldschmidt, MA

      My heart goes out to you, Priscilla. That must be so frightening and upsetting for you! I want to offer you encouragement to nourish your body and take care of yourself by eating a pH-balanced diet and doing what exercise you can. Your body was made for health, and now that you are drug-free, it has a chance to heal and recover when given what it needs. I wish you great success moving forward with your bone health!

  4. Priscilla cunningham

    I just submitted my story typo error meant to say rod in hip down thigh to knee severe pain every day on dilaudid 3 yrs after surgery pains and aches all over bedridden with also growths on gums from jaw I’m scared and no longer have a life

  5. Priscilla cunningham

    After many years on Bonita are dis y fest shot of Reclast caused immediate pain in my thigh got worse every week dr said it was ok then 3 weeks later my femur shattered After 2 surgeries snd s tod in my hip to knee 3 yrs ago I’m still having severe pain have yo take dilaudid and anti anxiety imscsredyo death bedridden most of the time in severe pain and aches all over Other leg severe pain as well I have no life dr cut town the dilaudid snd pain is horrible Surgeon said Reclast positioning wheelchair for 8 months after surgery growths on my gums snd jaw ad Zim very drpressed snd scaredHe also said at time of surgery Reclast will be in my body for 20 years doing damage m in bed in pain when it rains unbearable What can I do I’m 68 look in my 40s and feel in my 90s divorced alone life ruined due to Reclast and 6 yrs of biphosphate drugs

  6. Beth V.

    Yesterday my 80-year-old mother was told she can never have dental surgery again although she desperately needs it because her bones can no longer heal. She fell and fractured her ulna (elbow) four weeks ago, and according to the x-rays from last week, the fracture still “looks like the first day she broke it.” The oral surgeon said her 12 years on bisphosphonates (Reclast, Fosamax, etc.) is likely the reason for her failure to heal. Because the blood supply to the gums is less efficient than that to the elbow, you can imagine how horrible it would be if she had had the surgery. Now she faces a future where her teeth, however painful or infected, will have to come out naturally. I urge everyone who reads this to stop taking these bisphosphonate medications. They impede the ability of bones to heal.

  7. Lynn Lonergan

    I have osteoporosis and am currently injecting Forteo once a day to increase my bone density, which was at low Tscore of -5. I cannot take these injections for more than a year due to the recommendations of the FDA. I don’t know if this medicine has biophosonates contained in it.
    What does your research show?

    • Vivian Goldschmidt, MA

      Hi Lynn,

      Forteo is not a bisphosphonate. It was developed as an alternative to bisphosphonates, in fact. If you’d like to read more about this puzzling drug, I suggest you use the Search feature at the top of the page – I have written quite a bit on Forteo! 🙂 Here is a link to one of my posts on Forteo to get you started:

      https://saveourbones.com/forteo/

  8. Brian Herbert

    Hi Vivian,

    I am 68 years old, and have recently fractured the bone in my foot. (I think it is the 5th metatarsal). The Doctors now want to insert a pin, as the bone refuses to weld. What do you suggest?

  9. Eileen

    I’m 66 years old and sustained a compression fracture of my thoracic spine in Feb, 2015 (I jumped off a cliff into water, bent my legs, smacked down hard and compressed a vertebrae). A dexa scan after that showed osteoporosis, and I refused to take the fosamax. I’m using True Osteo 2 capsules a day, hiking 40-60 minutes daily, eating black sesame seeds, almond butter and other calcium-rich foods (I’m vegan). I teach yoga several times a week and do many of the exercises you recommend. Yesterday, after xrays for recent back pain, I learned I have three more mild to moderate compression fractures in my lumbar spine! My dexa scan 2 days ago showed slight improvement in my T scores, but my spine seems to be deteriorating. Do you think I need more calcium/D? Should I start eating sardines and salmon? I’m frustrated.

  10. shula

    thanks

  11. Carmen Dawe

    Hello again, Vivian,

    I read in your newsletter that almonds are good for the bones. How many should I eat on a daily basis for them to have an impact. Thank you very much.

  12. Carmen Dawe

    I just read your link referring to Prolia, so I’ve been answered!!! Thank you, Vivian

  13. Carmen Dawe

    Dear Vivian,

    I am 68 years old and have been diagnosed with osteoporosis, at a moderate risk of fracture (according to them). They prescribed an inyection of Prolia, which I didn’t accept. What do you know about it? They told me it was different from the previous medicines for osteoporosis, like Fosamax. Can you tell me something about it and if I did the right thing? I already have your program and try following it. Thank you very much.

  14. Julie Jones

    I was diagnosed with osteoporosis at age 51 in 2002. The doctor prescribed fosamax and told me I would be on it for life. Then they learnt differently. I was on it for 7 years until they realized it should only have been 5. Since then, I have battled to improve my bone density but with little result. I am losing density at twice the rate of normal in my spine they tell me. I haven’t been able to understand why I don’t improve but after reading this article I think the light has dawned. The fact I was on the fosamax for 7 years has prevented my bone-building osteoblasts from being able to do their job, despite stopping the drug. I have been seeing a naturopath who was sure I would improve, but after 2years I am much worse. I am following your program now Vivian thank you, strength training, eating an alkaline diet and I won’t know for another 2 years if anything has improved. The doctors won’t even appove any tests I’ve requested so that I may see if there are changes eg. bone turnover tests, blood tests etc., or refer me to a specialist. It’s either too costly or they don’t believe you are going to improve and thus put you on the scrap heap! They tell me “It’s your hormones”, but they aren’t interested any further than that, only if I concent to take other drugs. It makes you feel like banging your head on the floor in front of them! I am sure there is something else causing this, there has to be, but they make you feel like you have been dumped by the roadside! 14 years of time wasted! I am taking myself to an endocrinologist next week, in the city, a long flight from where I live. I’m hoping he may shed some light on the situation.
    Thank you Vivian for all you do. Your dedication to us all is amazing!

    • Julie Jones

      Hi, further to my comment on May 2, I have finally seen an endocrinologist and he is doing tests. He thinks that no matter what I do, I’m not absorbing the calcium in my diet or supplements. My blood calcium count is high and I may have a parathyroid tumor which is fixable!! Also checking for celiac and a few other things. If your doctor isn’t helping you and your bone density isn’t improving, try another one and another, until you get satisfaction! You need to do your research and push on from there. You think that your doctor is doing the best they can for you (many do!) but I can’t believe that mine let me get this bad and still refused to refer me to a hormone specialist. She tried to put me back onto drugs, which if the above tests prove positive, would not have done one bit of good. Um, they don’t anyway. I have now been informed that out of 100 women with osteoporosis, there would only be 2 who were worse than me! Far out! Talk about scary!

  15. Melanie yeager

    I have been told dairy is bad. I usually eat Swiss or cheddar cheese for lunch. Also eat two eggs in the morning. And a little milk on cereal. Thanks for your response. I am finding all your information most helpful. Melanie

    • Allison

      There’s nothing “bad” about dairy unless you happen to have an allergy to dairy products or a lactose intolerance. There are too many fad diets out there these days, proclaiming that certain foods are “healthy” vs. “unhealthy.” People should just try and follow a more or less balanced diet. Going above and beyond that will net you few if any actual benefits.

  16. Dahna Berkson

    I’m not quite certain this was so cinister a cover up or a terrible paradox, discovered once patients were taking this drug beyond 5-8 years. Vivian, its about DURATION of exposure. It doesn’t mean the drug doesnt have benefit at all.

    I get your nutritional and exercise premise, and it’s a good one. So I am not disputing your premise either.

    But it doesn’t necessarily exclude all options, within scientific reason.

    Patients were taking Fosomax for too long. And this is no longer the practice. It’s monitored and discontinued after 5 years or so, I believe.

    • Allison

      Duration doesn’t always have to be long for adverse effects to occur. See Helen S’s comment directly below yours, e.g. And I’ve read many similar posts from people who took the meds briefly yet sustained serious side-effects.

  17. Helen Schulman

    Thank you for this story. Last year my bone density test went from osteopenia to osteoporosis for the 1st time, so my doctor advised “Prolia”. I had 2 injection, 6 mths. apart. All of a sudden I developed a right side femur fracture. The fracture healed, but then I developed “Arterial Vascular Necrosis (AVN)” of the right femur from this. My doctor won’t believe it is from Prolia, but I know it is. Now I’m being told I need hip replacement surgery for this. The condition is very painful. I’m trying stem cell therapy as an alternative and hope for the best. My advise to others is to stay away from these type drugs! It’s dangerous and expensive to try to heal afterwards.

    • Vivian Goldschmidt, MA

      I am sorry to hear about your fracture, Helen!

      Prolia is an example of an alternative to bisphosphonates that is touted as “safer” by the Establishment (but it isn’t). There’s a link to my review of Prolia in the post above, but here it is again if you’d like to read more about this drug:

      https://saveourbones.com/prolia-denosumab-review/

  18. Tricia Brierly

    I think the witholding of this vital information about the drug and not withdrawing it is disgusting and irresponsible.
    Is this not the drug that can cause irreversible jaw rot also? You do a wonderful job alerting people to it’s dangers and giving natural treatment programmes and ongoing support
    for preventing osteoporosis.

  19. Valentine Balass

    Dear Vivian,
    I broke my femur September 2011. after a fall. I am now on Prolia injection & Carbocal D 1000 500mg.My doctor says I am no more in the category of oestoperoses, but should continue in this treatment. I am frankly very scared, now should I continue or should I ignore my Doctor’s recommendation? What do you think? I exercise religiously every single day, I am now 83 years old?
    .

    • Vivian Goldschmidt, MA

      Welcome, Valentine! As to whether or not you choose to continue with the Prolia treatment is your decision. Research, learn as much as you can, and then decide. It’s your body and your health!

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