Rapid Responses to:

LETTERS: Stuart H Ralston, Gina de’Lara, Donald J Farquhar, Stephen J Gallacher, Jim Hannan, and Alastair R McLellan Women over 75 with fragility fractures should have DEXA BMJ 2009; 338: b2340 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Alendronate does reduce fractures in patients with vertebral compression

Susan Ott   (23 July 2009)

Alendronate does reduce fractures in patients with vertebral compression 23 July 2009
Susan Ott, Assoc. Professor, Medicine University of Washington 98195 Send response to journal: Re: Alendronate does reduce fractures in patients with vertebral compression	Dr. Ralston stated that alendronate did not reduce fracture risk in patients with osteopenia, and cited the Fracture Intervention Trial. However, the women in the arm of the study which he cites did not have vertebral fractures. In the other arm (those with vertebral fractures) alendronate was effective, even though the subjects did not all have a bone density in the "osteoporosis" range. Remember that the FIT trial was designed before the World Health Organization defined osteopenia. The cut-off for entry into the trial was an absolute bone density of .68 g/cm2 at the femoral neck, based on risk analysis from the prior Study of Osteoporotic Fractures. In the non-vertebral-fracture arm of the FIT trial, the fracture rate was lower than anticipated when the study was designed. The overall clinical fracture rate was not significantly better in the alendronate group than in the placebo group. In a secondary analysis, those with "osteoporosis" were found to have fracture reduction with the medication. Therefore, it does make sense to treat patients older than 75 who have had a vertebral compression fracture, without necessarily measuring the bone density. Competing interests: None declared