Until midlife, most women don't think too much about their bones. Out of sight – out of mind. But after menopause, bone health can become a major issue. Ten million Americans over age 50 already have osteoporosis, which is a bone disorder characterized by thinning bones, and another 34 million are at risk for it. (You're at risk of osteoporosis if you're thin or small-framed, have a personal or family history of fractures, or have had an eating disorder, among other factors.)
A generation ago, there wasn't much that could be done for women suffering from osteoporosis. Many of us had mothers or grandmothers who suffered from this disease, which caused them to develop what used to be known as a "dowager's hump" in their backs. But in recent years, a class of drugs called bisphosphonates has offered some hope for women at risk for osteoporosis or already suffering from it.
These drugs were widely prescribed in the last decade. The FDA says that as many as five million prescriptions are filled every year for bisphosphonates, which include drugs with the brand names Aclasta, Actonel, Altevia, Boniva, Fosamax and Reclast. You've probably seen the ubiquitous TV ads for them.
But some critics have questioned the safety and long-term effectiveness of bisphosphonates, especially if the drugs are taken for many years, and the FDA has been looking into the best way to prescribe them. Last week, an FDA advisory panel voted that labels on bisphosphonates should clarify how long patients can take them.
The problem is that no one can agree on what that time limit should be.
Generally, more than three to five years is considered long-term use of bisphosphonates but the FDA has received reports that a small number of women who were taking the drugs for that amount of time have suffered from osteonecrosis (bone death) in the jaw and unusual thigh bone fractures.
Some studies also suggest that women may continue to benefit from bisphospohnates for years because the drugs stay in the bones. Other bone scientists say the research isn't clear on who benefits from long-term bisphosphonate use.
It's important to note that taking drugs isn't the only way to strengthen bones at midlife. Weight-bearing exercises can work well if they're prescribed by a physical therapist or personal trainer who specializes in improving bone strength.
As you approach menopause, you should talk to your doctor about what you can do improve your bone health.