22. Five years

Five years is the usual course for alendronate, the drug that dampens the enthusiasm of osteoclasts, the bone cells that dismantle bone structure, a process followed by osteoblast remodeling/rebuilding.  Why just five years? Well, there are side effects--gastritis, osteonecrosis of the jaw, possible increase in femur fractures, all very rare but harder to ignore with each passing year.  Also, the effect of alendronate lingers, so my osteoclasts remain inhibited--or so they say.  But before deciding whether to continue alendronate or perhaps consider other approaches, some form of assessment is in order.  A bone density test obtained two years after the start of alendronate showed marked improvement; let's see if that progress has been maintained. \