How might alendronate (Fosamax) affect cardiac calcium scores obtained on CT scanning and possibly the clinical end points? Are there any studies or case reports?
—James J. King, MD, Tacoma, Wash.

The potential therapeutic relationship between bisphosphonate usage and coronary artery calcification is intriguing. Thus far, the clinical data are scant and conflicting. One group of researchers showed that inhibition of bone resorption using bisphosphonates in rats did in fact reduce coronary arterial and valvular calcification in a dose-dependent fashion (Arterioscler Thromb Vasc Biol. 2001;21:817-824). The authors speculated that a physiologic relationship exists between calcium resorption from bone and arterial deposition. Another study compared 56 patients taking a bisphosphonate with 56 age-matched controls and a reference population. The authors postulated that bisphosphonates would inhibit calcium resorption from plaques, thereby accelerating the rate of coronary artery calcification. After 24 months, annual electron beam CT showed progression of coronary artery calcification in both groups, without a statistically significant difference in alendronate-treated subjects.
—Christopher Ruser, MD (100-15)

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