Larger increases in bone mineral density during alendronate therapy are associated with a lower risk of new vertebral fractures in women with postmenopausal osteoporosis

Abstract

Women with increases of > or =3% in BMD during the first 1 or 2 years of alendronate treatment had the lowest incidence of new vertebral fractures. These findings suggest that, among women taking antiresorptive agents, greater increases in BMD are associated with lower risk of new vertebral fractures.

Proportion of osteoporotic women remaining at risk for fracture despite adherence to oral bisphosphonates

“…A significant decline in BMD was observed in 16% of our subcohort having pre-and post-treatment DXA, which was considerably higher than in clinical trials [16,17]. However the fracture rates were comparable between our study and clinical trials of oral bisphosphonates.…”

“…According to the findings of Hochberg et al, both absolute BMD and the magnitude of change on treatment had additive effect on the risk of fractures in bisphosphonate treated subjects in clinical trials [16]. A significant decline in BMD was observed in 16% of our subcohort having pre-and post-treatment DXA, which was considerably higher than in clinical trials [16,17].…”

“…Furthermore persistence of osteoporotic T-scores or further decrease in BMD after treatment indicates a higher risk of subsequent fracture compared to those with higher post treatment T-scores, and potential to benefit from additional treatment [15]. Thus the outcomes of fracture, or the surrogate outcomes of decline in BMD or persistent low BMD, are often used by practitioners to guide decisions regarding continuing or switching therapies, because the occurrence of each of these is associated with an elevated risk of fracture relative to other treated patients [16,17].…”

Sex and Gender Considerations in Male Patients With Osteoporosis

“…These medications provide relatively comparable prevention of vertebral and nonvertebral fractures in both sexes [23,26,43,45,46], although the data on men are limited due to underenrollment of men in pharmacologic studies [39,49]. Anabolic agents, such as parathyroid hormone (PTH) 1-34, PTH 1-84, and strontium ranelate, lead to comparable bone mass enhancement and fracture protection in both sexes [29,35,40].…”

Postmenopausal osteoporosis treatment with antiresorptives: Effects of discontinuation or long-term continuation on bone turnover and fracture risk—a perspective

“…(4) In the Multiple Outcomes of Raloxifene Evaluation (MORE) study, only 4% of vertebral fracture reduction in raloxifene-treated women could be attributed to BMD changes. (5) However, some reports have demonstrated stronger correlations between BMD increases and fracture reduction; eg, vertebral fractures in women treated with alendronate or ibandronate, (6,7) and vertebral and nonvertebral fractures with denosumab. (8) Similarly for zoledronic acid, a large proportion of the antifracture effect is related to BMD accrual.…”