So how much does the risk increase? And please cite your number.
Well, your number of 0.2% increases to 0.5-1.7%, so thatâs about 2.5X to 8X increase. My source is Gemini.
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Well this has been an informative thread. Appreciate the information and insights. Had been thinking about starting (re-starting) an alendronate but I think I wonât. The evidence seems to suggest that the risks of osteonecrosis are quite low if you are taking an oral alendronate (as opposed to an infusion) but knowing what we know about how drug works (kills or deactivates the osteoclasts) I just donât think I want to do this. Also, n=1, a friend who has multiple myeloma was given zometa infusions as a counter to one of the chemo drugs she had to take. She developed osteonecrosis of the jaw. It was extremely painful and it was just about impossible for her to open her mouth and move her jaw, much less eat, and then it led to a major infection. So, I know that has entered into my very imperfect assessment about whether to take a fosamax-like drug.
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The risk is higher when used with regards to cancer than osteoporosis according to Wikipedia.
In patients taking drugs for cancer, the likelihood of MRONJ development varies from 0 - 12%. This again, varies with the type of cancer, although prostate cancer and multiple myeloma are reported to be at a higher risk.[8]
In patients taking oral drugs for osteoporosis, the likelihood of MRONJ development varies from 0 - 0.2%.[7]
The trial I linked had 1 case for placebo 1 for zoledronic acid over 3 yrs in 3889 patients in total with 1 injection yearly. The question is how many years do one even take them�
Something to consider in the risk/reward calculation. If youâre old, donât fall down! But bisphosphonates can reduce the risk if youâre osteoporotic.
- In the US, how many die from fall-related complications per year. I.e., elderly person falls, breaks hip, bedridden, physiological decline, death.
About 41,000 older adults (65+) died from falls in 2023. The CDCâs reported unintentional fall death rate for adults 65 and older was 69.9 per 100,000 in 2023, and press coverage of the same CDC report summarized that as âover 41,000â deaths. (cdc.gov)
That is the cleanest official number for deaths attributed to falls. It already includes a lot of what you are talking about: the fall, the injury, the hospitalization, the downstream decline, and then death being coded as fall-related. But it also misses some cases where the final death certificate gets coded under something else, so it is not a perfect capture of the whole cascade. That means the true âfell, declined, then diedâ burden is probably somewhat larger than the headline fall-death number. (cdc.gov)
For the specific hip-fracture pathway:
- The CDC says there are about 300,000 hip-fracture-related hospitalizations each year due to older adult falls. (cdc.gov)
- After a hip fracture, one-year mortality is commonly around 17% to 25% in older adults in modern studies/reviews. (pmc.ncbi.nlm.nih.gov)
That does not mean all of those deaths are directly caused by the fracture alone, because these patients are older and frailer to begin with. But clinically, the sequence you described is very real: fall â hip fracture â immobility/delirium/deconditioning/infection/loss of independence â death. (pmc.ncbi.nlm.nih.gov)
So the practical answer is:
- Directly counted U.S. fall deaths in older adults: about 41,000/year
- Hip fractures from falls: about 300,000 hospitalizations/year
- One-year death rate after hip fracture: roughly 1 in 5, sometimes a bit lower or higher depending on age, sex, frailty, and comorbidities (cdc.gov)
Confidence: high for the ~41,000 U.S. fall-death figure; medium-high for using hip-fracture mortality to estimate the downstream âbedridden then declineâ burden, because attribution gets messy.
It is relative to the 65+ population, not the whole U.S. population. The CDC brief is explicit: âthe unintentional fall death rate for adults age 65 and older was 69.9 per 100,000 population,â and the table is for âadults age 65 and olderâ with 41,400 deaths. (cdc.gov)
Same thing for the age subgroups in that table:
- 65â74: 19.2 per 100,000 people age 65â74
- 75â84: 74.7 per 100,000 people age 75â84
- 85+: 339.5 per 100,000 people age 85+ (cdc.gov)
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Agreed, that 's why you need to carefully evaluate your own individual situation. Are there contraindications in you case? Interactions with other drugs, special considerations? If you are about to have dental procedures involving extractions, implantations or other bone involvement, even root canal - well, stop the bisphosphonates, or wait until after, with a good safety margin. Clearly. Spontaneous osteonecrosis with no precipitating factor (such as surgery) is very rare. So if there are no special contraindications, and you have severe osteoporosis, I personally (not a doctor, not medical advice) would keep in mind that the benefits outweigh the risks⌠and again,bisphosphonates lower all cause mortality. YMMV.
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Agree with what others have said-- that it has to be a personalized decision based on your own particulars. The bone marker tests that I did years ago showed that my resorption levels were normal, not elevated, (despite having osteoporosis) so a bisphosphenate, which is basically an anti resorptive, would not be a good drug for me. If the bone markers had shown high resorption levels, I would most probably have taken the bisphosphenates. Perhaps I will get the bone markers repeated.
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How can you predict you will never need a root canal or extraction, thatâs just impossible unless someone is already edentulous.
I would opt for high protein, vit k2/d3 magnesium/boron/calcium supplementation and resitance training first
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Arhu, I agree with you. Resistance training, vibrating platform, biking and walking, K2Mk7 and MK4, magnesium, D and raloxifene. Osteoporosis is kind of like Alzheimers â in that we have been treating manifestations of the primary problem (tau, Amyloid, and disrupted bone remodeling) instead of root causes. In the case of Alzheimers we are now recognizing that it is initiated by inflammation, and disrupted glucose regulation. I have not seen information anywhere about supposed root causes of osteoporosis but I suspect that there is an underlying metabolic/inflammatory and maybe hormonal constellation of factors that start the imbalances in the bone remodeling.
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Deborah, if I can add a nano observation regards osteoporosis, try to add some form of impact signal to your physical routine. Many standard recommendations focus on low-impact weight-bearing activities and resistance/strength training, which are excellent and safe for most people with osteoporosis. However, if you can, impact provides a stronger stimulus for bone remodeling, especially in the hips, spine, and legs (a process called Wolffâs Law).
Best, xx
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On your good note @Raquel incase itâs helpful, Iâll share what my PT has advised me to do at homeâŚ
I have weighted medicine balls (16 and 20 lbs)⌠I bounce them and when I catch them, he said that it giving me full body impact. And no fall risk!
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Hi Beth!
As far as I know, weighted ball exercises are occasionally mentioned in broader programs as part of UPPER-body/impact loading in case studies or protocols. However, they were not studied in isolation or compared head-to-head with LOWER-body impact activities for osteoporosis. Please, ask your PT for the comparative studies that he has based his recommendation⌠My understanding on this matter so far is that you need to generate ground reaction forces through your feet and legs hitting the ground to get the strongest bone-building stimulus at key sites like the hip and spine â but hey, your PT may know better: ask him for the comparative clinical studies done.
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Your point about needing to âgenerate ground reaction forces through feet and legsâŚâ This is why a vertical (must be vertical, not side-to-side) oscillation can be beneficial as a stimulus for bone remodeling and a way to reduce/prevent the development of disrupted bone remodeling (osteoporosis).
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Saw my PT today⌠he agrees with you that if someone does not have severe osteoporosis that impact is great (jumps etc).
Having said that, if someone has advanced osteoporosis he would never recommend it because there is just too much risk of a stress injury, and itâs not necessary.
He said catching a heavy ball gives you more sudden impact than jumping, and itâs heavier than the ball when you are catching the weight, even if itâs not heavier than landing body weight.
That is his opinion
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Another thought about how to get âimpact:â I step up-up, down-down over and over on the stairs to the beat of music â âRondoâ from the After Bach album by Brad Mehldau. Itâs about 8 minutes. Before I had the Peloton I did this every day, sometimes with ankle weights. Now I only do it a couple of times per week as an adjunct to the bike.
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Actually, thatâs toward the high end of normal. Pretty good.
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