Bob VogelQ. I’m a T10 complete para, 25 years post-injury. Ten years ago I broke my femur during a simple fall out of my chair. The tumble was not as bad as the big-time falls I used to take playing wheelchair football. My doc ordered a bone scan, which showed no problem in my spine but osteoporosis in my hips, and she put me on Fosomax. I’ve taken it once a week ever since. However, subsequent bone scans don’t show any improvement in my hips.

Lately I’ve read articles suggesting long-term use of drugs like Fosomax can cause serious side effects. Is there information on whether these types of drugs help prevent fracture in people with SCI?

— Kirk

A. Fosomax is the brand name for alendronate sodium, an oral medication in the bisphosphonates family of drugs that are used to treat osteoporosis, a condition in which bones become so porous they fracture easily.

In order to understand how bisphosphonates work, it is important to understand that bones are living tissue. Throughout our lives new bone is growing and replacing old bone that is absorbed by the body. Bone tissue grows faster than it is absorbed, reaching maximum strength and density — known as peak bone mineral density — around age 30. After that, bone absorption slowly outpaces growth. Osteoporosis is bone loss of about 28 percent or more. Biphosphonates help increase BMD by binding to the surfaces of the bones and slowing down bone reabsorption, enabling bone-building cells to catch up.

Like all medications, bisphosphonates have possible side effects, including nausea, heartburn, possible damage to the esophagus, and gastric ulcer. In nondisabled people there have been rare reports of unusual