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Dr. Ralston stated that alendronate did not reduce fracture risk in
osteopenia, and cited the Fracture Intervention Trial. However, the women
the arm of the study which he cites did not have vertebral fractures. In
arm (those with vertebral fractures) alendronate was effective, even
subjects did not all have a bone density in the "osteoporosis" range.
Remember that the FIT trial was designed before the World Health
defined osteopenia. The cut-off for entry into the trial was an absolute
density of .68 g/cm2 at the femoral neck, based on risk analysis from the
Study of Osteoporotic Fractures.
In the non-vertebral-fracture arm of the FIT trial, the fracture rate
than anticipated when the study was designed. The overall clinical
was not significantly better in the alendronate group than in the placebo
In a secondary analysis, those with "osteoporosis" were found to have
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