2. Bone Remodeling

Just like my 100 yr old house that's constantly undergoing remodeling--tearing down and then building up--bones constantly undergo a dynamic remodeling.  Osteoclasts are bone cells that tear down bone structure and osteoblasts build them up.  Bones are healthiest when osteoclasts and osteoblasts balance.

When osteoclasts outrun osteoblasts--tearing down without repair--bones become less dense and more vulnerable to fracture.  It's okay to remove some studs in that wall that you've decided to take down, but if you don't replace that support with horizontal beams or replacement vertical studs, then the house is weakened, vulnerable to winds, earthquakes, whatever, a house of twigs .

1. Biphosphonates

DAY ONE-- of treatment, anyway, a bisphosphonate called  Alendronate 70mg, taken just once weekly as follows:

1. on an empty stomach (food or meds can block absorption)
2. remaining upright for 30 minutes (to prevent reflux into the esophagus, the esophageal sphincter not being totally waterproof),
3. and with a full glass of water (to dilute the alendronate in case some reflux occurs)

I think I'll make it 45-60 minutes, just to be sure.  Alendronate esophagitis is probably the most common serious adverse side effect, ranging from mild heartburn to life-threatening esophageal ulcerations.

Then there is the rare but scary osteonecrosis of the jaw (you have to admit that plugging "necrosis" into any discussion is bound to provoke anxiety), which can occur after major jaw surgery in patients taking biphosphonates such as alendronate.