Osteoporosis

Osteoporosis
       

• 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.