Stuart H Ralston, Gina de’Lara, Donald J Farquhar, Stephen J Gallacher, Jim Hannan, Alastair R McLellan et al
Ralston S H, deâLara G, Farquhar D J, Gallacher S J, Hannan J, McLellan A R et al.
Women over 75 with fragility fractures should have DEXA
BMJ 2009; 338 :b2340
doi:10.1136/bmj.b2340
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
Competing interests: No competing interests