The Association Between Low Bone Mass at the Menopause and Cardiovascular Mortality.
P von der Recke, et al (ctr for Clinical and Basic Research, Ballerup, Denmark) Am J Med 106: 273-278, 1999.
Conclusion: Low bone mass is a significant predictor of increased mortality, especially cardiovascular mortality in postmenopausal women.
Two consequences of postmenopausal estrogen deficiency are osteoporosis and accelerated development of atherosclerosis. Therefore, it is not surprising that women with osteoporosis are at increased risk of dying of cardiovascular disease. Administration of estrogen replacement is an effective way to prevent osteoporosis and also reduces the risk of a myocardial infarction. Cardiovascular disease is the main cause of death in women, and giving estrogen replacement after menopause increases a woman’s life span.
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)
Effect of Alendronate on Risk of Fracture in Women with Low Bone Density but Without Vertebral Fractures: Results from the Fracture Intervention Trial.
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.
Black DM, for the FIT Research Group (Univ of California, San Francisco; et al)
Fracture Risk Reduction With Alendronate in Women With Osteoporosis: The Fracture Intervention Trial
J Clin Endocrinol Metab 85: 4118-4124, 2000
Methods: The effect of alendronate treatments on the risk of new fracture was examined in 3658 women with osteoporosis from 11 clinical centers in the United States who were enrolled in the Fracture Intervention Trial.
Editor’s Comments: The results of this large, randomized trial provide a high level of evidence that administration of 10 mg of alendronate daily to women with osteoporosis without a prior fracture results in a rapid and significant decrease in subsequent incidences of fractures at many sites. Therefore, treatment of postmenopausal women with, established osteoporosis with alendronate is advisable.
Tonino RP, for the Phase III Osteoporosis Treatment Study Group (Univ of Vermont, Burlington)
Skeletal Benefits of Alendronate: 7-Year Treatment of Postmenopausal Osteoporotic Women
J Clin Endocrinol Metab 85: 3109-3115, 2000
Methods: The extended study included 235 women who were blinded to treatment with alendronate (5 or 10 mg daily) and 115 women formerly treated with alendronate who were now switched to a blinded placebo.
Editor’s Comments: The results of this study indicate it is safe and effective to administer alendronate for 7 years to postmenopausal women to prevent bone loss. BMD of the lumbar spine continues to increase in the sixth and seventh year of alendronate therapy for postmenopausal women with established osteoporosis.
Unlike, estrogen once alendronate is incorporated into bone it has an extremely long half-life. It was found in this study that after 5 years of treatment with alendronate, BMD did not decrease in the subsequent 2 years when placebo was given. When estrogen therapy is dicontinued, there is a rapid decrease in BMD. Thus, alendronate has a longer duration of action than estrogen.
Tiras MB, Noyan V, et al (Gazi Univ, Ankara, Turkey; McMaster Univ, Hamilton, Ont, Canada)
Effects of Alendronate and Hormone Replacement Therapy, Alone or in Combination, on Bone Mass in Postmenopausal Women With Osteoporosis: A Prospective, Randomized Study
Hum Reprod 15: 2087-2092, 2000
Conclusion: Alendronate was more effective than HRT alone and could be beneficial when added to the HRT regimen for patients with postmenopausal osteoporosis. Alendronate may also be used for postmenopausal women with osteoporosis when HRT use in contraindicated or when the patient is reluctant to use hormonal treatment.
Editor’s Comments: In this study, alendronate with or without HRT resulted in a significantly greater BMD increase in the spine in women with osteoporosis than did HRT alone. There was no difference in the increase in BMD in the hip between alendronate with or without HRT and HRT alone.
There are no data showing that the combination of alendronate and HRT results in more of a decrease in subsequent fracture incidence in women with osteoporosis than occurs with the use of HRT alone. However, clinicians may decide to treat women with established osteoporosis with both antiresorptive agents rather than either alone because of the better effect upon spinal BMD with combination therapy.