Effect of Alendronate on Risk of Fracture in Women with Low Bone Density but Without Vertebral Fractures: Results from the Fracture Intervention Trial.
SR Cummings, for the Fracture Intervention Trial Research Group (Univ of Calif, San Francisco; Merck Research Labs, Rahway, NJ; Univ of Tenn, Memphis; et al)
JAMA 280: 2077-2082, 1998.
Conclusion of the study was Alendronate safely increased bone mineral density and decreased the risk of first vertebral deformity in women with low bone mineral density but without vertebral fracture. Among women with osteoporosis, alendronate significantly reduced the risk of clinical fractures; however, this was not seen in women with higher bone mineral density.
Editorial comment: This randomized controlled trial provides much useful information about the effects of alendronate on bone density and fracture risk. A group of postmenopausal women without evidence of vertebral fracture were treated with alendronate or placebo for 4 years. A significantly reduced risk of osteoporotic fractures with alendronate occurred only among those women who had evidence of osteoporosis before entering the study, not those without osteoporosis. Estrogen remains the best therapy for prevention or treatment of osteoporosis. Estrogen has additional health benefits, but alendronate only prevents the progression of osteoporosis. Also unlike estrogen, which has been shown to maintain bone preservation for decades studies with alendronate have been limited to 4 years. Thus, alendronate should only be used to treat osteoporosis among women who have contraindications or who are unwilling to take estrogen.