Alendronate and nonhormonal breaks?
Are there any studies on alendronate (Fosamax) therapy for nonhormonally related fractures?
—Jorge Guzman-Ortiz, MD, Jayuya, P.R.
There is a small but growing body of literature examining the use of bisphosphonates for the treatment of osteoporosis in patients other than postmenopausal women. Two of the largest such “at-risk” groups are men and patients being prescribed glucocorticoids for intermediate to long-term use. One group of researchers conducted a meta-analysis of the antifracture efficacy of alendronate in men who had “low bone mass or history of prevalent fracture.”
Overall, treatment with alendronate resulted in decreased risk of vertebral fractures but no statistically significant difference in the rate of nonvertebral fractures (BMC Musculoskelet Disord. 2005;6:39). Others have examined the use of bisphosphonates to treat glucocorticoid-induced osteoporosis.
The clinical implications of this question are significant. Not only is there a broad range of diseases for which glucocorticoids remain the mainstay of treatment, but usage for even as few as three months can increase risk for rapid bone loss. Multiple trials with alendronate or risedronate and calcium/vitamin D supplementation have shown statistically significant improvements in lumbar spine bone mineral density and relative reduction in vertebral fracture risk (N Engl J Med. 1998;339:292-299, Arthritis Rheum. 2001;44:202-211, Calcif Tissue Int. 2000;67:277-285).
— Christopher Ruser, MD (117-15)