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Alendronate Reduces Fracture Risk in Women With Low Bone Density

Alendronate reduces fracture risk in women with a prior history of vertebral fractures, but does it have a role in primary prevention of fractures? This randomized, blinded, placebo-controlled trial of 4,432 women aged 54 to 81 sheds some light on the matter. The trial included only women with femoral neck bone density at least 1.6 standard deviations below the normal young adult mean.

During an average follow-up period of 4.2 years, there was no statistically significant decrease in clinical fractures with alendronate therapy. Alendronate did significantly decrease fractures (by 36 percent) in the third of women with the lowest bone density (more than 2.5 SD below the normal young adult mean), but there was no effect in subgroups with higher bone density. Vertebral films at the conclusion of the study found a 44 percent lower risk for radiographic vertebral fractures with alendronate therapy.

Comment: Although this study showed a significant benefit from alendronate therapy in women with the lowest bone density, an accompanying editorial called the lack of significant results in the total population "somewhat disappointing." Before alendronate is embraced for primary prevention of fractures, testing strategies must be devised to identify patients most likely to benefit from this therapy.

— TH Lee

Published in Journal Watch General Medicine January 15, 1999

Citation(s):

Cummings SR 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 1998 Dec 23 280 2077-2082.

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• Medline abstract (Free)

Heaney RP. Bone mass, bone fragility, and the decision to treat. JAMA 1998 Dec 23 280 2119-2120.

• Original article (Subscription may be required)
• Medline abstract (Free)