Bisphosphonates for Osteopenia in Postmenopausal Women

To the Editor The JAMA Insights article on bisphosphonates for postmenopausal osteoporosis commented that no clinical trials have assessed benefit of treatment with bisphosphonates in women with osteopenia. I disagree. A double-blind, randomized, placebo-controlled trial of nearly 2000 older women with osteopenia with average bone mineral density (BMD) T scores between −0.91 at the lumbar spine and −1.67 at the femoral neck showed a fracture reduction rate at 6 years of at least 33% from intravenous zoledronate given at 18-month intervals. The reduction in hip fracture rates did not achieve statistical significance; however, the fracture reduction rates outsid e the hip occurred without the adverse effects of jaw osteonecrosis or atypical hip fractures. The results held true even when data from a subset of 163 women with osteoporosis who were included in the study were later excluded from statistical analysis. The results are remarkable given that 62 of t he 954 women (6.4%) in the treatment group received only 1 infusion of zoledronate because of acute phase reactions or iritis and that 115 women (12.2%) in the placebo group vs 33 (3.5%) in the treatment group received bisphophonates outside the study. In addition, the benefits of zoledronate were s ustained in women with or without 10-year baseline fracture risks of greater than 3% for hip fractures and 20% for any fracture as determined by the Fracture Risk Assessment Tool (FRAX) calculator proposed by the National Ost...
Source: JAMA - Category: General Medicine Source Type: research