Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures

Black, Dennis M.; Cummings, Steven R.; Karpf, David; Cauley, Jane A.; Thompson, Desmond; Nevitt, Michael C.; Bauer, Douglas C.; Genant, Harry K.; Haskell, William L.; Marcus, Robert; Ott, Susan M.; Torner, James C.; Quandt, Sara A.; Reiss, Theodore F.; Ensrud, Kristine E.

doi:10.1016/s0140-6736(96)07088-2

Cited by 3,440 publications

(2,132 citation statements)

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“…Another limitation is that the present study did not include a control group. Antifracture trials show that treatment with calcium and vitamin D alone has a mild antiresportive effect, (2)(3)(4)6,7) and it is possible that this may have slightly blunted the anabolic effects of teriparatide reported in the present study.…”

Section: Discussionmentioning

confidence: 62%

“…(1)(2)(3)(4)(5)(6)(7)(8) Generally, these can be divided into two types: (1) antiresorptive treatments such as bisphosphonates (1,2,4,6,7) that bring about a prompt decrease in biochemical markers of bone resorption followed a few months later by a reduction in bone formation markers (9) and (2) anabolic agents (currently only parathyroid hormone) (5,10) that bring about a prompt increase in bone formation followed a few weeks later by an increase in bone resorption. (11) Many modern treatments for osteoporosis have a profound effect on bone remodeling, and studies of bone turnover have an important role in the evaluation of their effect on bone quality.…”

Section: Introductionmentioning

confidence: 99%

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Differential effects of teriparatide on regional bone formation using 18F-fluoride positron emission tomography

Frost

Siddique

Blake

et al. 2010

Journal of Bone and Mineral Research

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Teriparatide increases skeletal mass, bone turnover markers, and bone strength, but local effects on bone tissue may vary between skeletal sites. We used positron emission tomography (PET) to study 18 F-fluoride plasma clearance (K i ) at the spine and standardized uptake values (SUVs) at the spine, pelvis, total hip, and femoral shaft in 18 postmenopausal women with osteoporosis. Subjects underwent a 1-hour dynamic scan of the lumbar spine and a 10-minute static scan of the pelvis and femurs at baseline and after 6 months of treatment with 20 mg/day teriparatide. Blood samples were taken to derive the arterial input function and lumbar spine K i values evaluated using a three-compartment model. SUVs were calculated for the spine, pelvis, total hip, and femoral shaft. After 6 months treatment with teriparatide, spine K i values increased by 24% (p ¼ .0003), while other model parameters were unchanged except for the fraction of tracer going to bone mineral (k 3 /[k 2 þ k 3 ]), which increased by 23% (p ¼ .0006). In contrast to K i , spine SUVs increased by only 3% (p ¼ .84). The discrepancy between changes in K i and SUVs was explained by a 20% decrease in 18 F À plasma concentration. SUVs increased by 37% at the femoral shaft (p ¼ .0019), 20% at the total hip (p ¼ .032), and 11% at the pelvis (p ¼ .070). Changes in bone turnover markers and BMD were consistent with previous trials. We conclude that the changes in bone formation rate during teriparatide treatment as measured by 18 F À PET differ at different skeletal sites, with larger increases in cortical bone than at trabecular sites. ß

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Section: Discussionmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Differential effects of teriparatide on regional bone formation using 18F-fluoride positron emission tomography

Frost

Siddique

Blake

et al. 2010

Journal of Bone and Mineral Research

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“…In the FIT (Fracture Intervention Trial), alendronate reduced the incidence of vertebral, wrist, and hip fractures by approximately half in women with prevalent vertebral fractures 90. In women without prevalent vertebral fractures, there was no significant decrease in clinical fractures in the overall population, but the reduction was significant in the one-third of patients that had a baseline hip BMD T-score lower than –2.5 SD 91.…”

Section: Pharmacotherapy Of Osteoporosismentioning

confidence: 99%

“…In a large population of elderly women, risedronate decreased significantly the risk of hip fractures (by 30%), an effect that was greater in osteoporotic women aged 70-79 years (40% reduction) 93. Ibandronate given daily (2.5 mg) reduces the risk of vertebral fractures by 50% to 60%,90 whereas an effect on non-vertebral fractures was only demonstrated in a post hoc analysis of women with a baseline of BMD T-score below –3 SD 95. Comparative and pooled (bridging) studies have shown that oral ibandronate 150 mg once monthly or intravenous ibandronate 3 mg every 3 months are equivalent or superior to daily ibandronate in increasing BMD and decreasing biochemical markers of bone turnover, giving rise to their approval for the treatment of postmenopausal osteoporosis 9697…”

Section: Pharmacotherapy Of Osteoporosismentioning

confidence: 99%

Updated Recommendations for the Diagnosis and Management of Osteoporosis: A Local Perspective

Raef

Al-Bugami

Balharith

et al. 2011

Annals of Saudi Medicine

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Postmenopausal osteoporosis and osteoporosis in elderly men are major health problems, with a significant medical and economic burden. Although osteopenia and osteoporosis are more common locally than in the West, fracture rates are generally less than in Western countries. Vitamin D deficiency is common in the region and contributes adversely to bone health. Vitamin D deficiency should be suspected and treated in all subjects with ostopenia or osteoporosis. The use of risk factors to determine fracture risk has been adopted by the World Health Organization and many international societies. Absolute fracture risk methodology improves the use of resources by targeting subjects at higher risk of fractures for screening and management. The King Faisal Specialist Hospital Osteoporosis Working Group recommends screening for women 65 years and older and for men 70 years and older. Younger subjects with clinical risk factors and persons with clinical evidence of osteoporosis or diseases leading to osteoporosis should also be screened. These guidelines provide recommendations for treatment for postmenopausal women and men older than 50 years presenting with osteoporotic fractures for persons having osteoporosis—after excluding secondary causes—or for persons having low bone mass and a high risk for fracture. The Working Group has suggested an algorithm to use at King Faisal Specialist Hospital that is based on the availability, cost, and level of evidence of various therapeutic modalities. Adequate calcium and vitamin D supplement are recommended for all. Weekly alendronate (in the absence of contraindications) is recommended as first-line therapy. Alternatives to alendronate are raloxifene or strontium ranelate. Second-line therapies are zoledronic acid intravenously once yearly, when oral therapy is not feasible or complicated by side effects, or teriparatide in established osteoporosis with fractures.

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“…A hip fracture may cost up to £12 000, depending on length of stay, whereas one year's cost of alendronate, which reduces the fracture risk by 50%, is £335. 33,34 Bisphosphonates are not only of interest because they inhibit osteoclast function, as they may also have direct antineoplastic effects. They inhibit bone invasion by prostatic carcinoma cells 35 and may therefore be useful for the prophylactic treatment of patients with cancers known to preferentially metastasise to bone.…”

Section: Discussionmentioning

confidence: 99%

Bone loss associated with the use of LHRH agonists in prostate cancer

Peters¹,

Fairney

Kyd

et al. 2001

Prostate Cancer Prostatic Dis

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Hypogonadism is a recognised cause of osteoporosis in men. When patients with advanced prostate cancer are treated with luteinising hormone releasing hormone (LHRH) agonist analogues their circulating testosterone levels decline and these patients may develop fractures.We have undertaken a cross-sectional study on a cohort of patients treated with goserelin (n ¼ 41) and compared their bone density and bone turnover with patients with prostate cancer not on goserelin and elderly patients living in the community.There was no difference in bone density between the patients on treatment and those living in the community and there was a similar incidence of osteoporosis (50 and 42%, respectively). The bone marker measurements were higher in the treated patients: urine N-telopeptide (NTX) 80.1 (9) (mean (s.e.)) BCE/mmol, compared to 30.1 (2.9), P < 0.001 in elderly patients; and bone alkaline phosphatase 41.9 (6.1) u/l in treated patients and 20.7 (1.5) in untreated prostate cancer patients, P < 0.002. Patients on treatment with radionuclide scan evidence of metastases did not have higher bone marker values than those with negative scans.As increased bone turnover and low bone density are associated with enhanced risk of osteoporotic fractures, we suggest that patients on LHRH agonist analogues should receive advice and possibly anti-bone resorptive treatment with bisphosphonates to prevent further bone loss and fractures. Prostate Cancer and Prostatic Diseases (2001) 4, 161-166.

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Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures

Cited by 3,440 publications

References 28 publications

Differential effects of teriparatide on regional bone formation using 18F-fluoride positron emission tomography

Differential effects of teriparatide on regional bone formation using 18F-fluoride positron emission tomography

Updated Recommendations for the Diagnosis and Management of Osteoporosis: A Local Perspective

Bone loss associated with the use of LHRH agonists in prostate cancer

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