Common Questions
What is the evidence that bisphosphonates prevent fractures in postmenopausal women with osteoporosis?
Multiple randomized controlled trials have demonstrated the ability of bisphosphonates to reduce vertebral and non-vertebral fractures in women with established osteoporosis.
| Bisphosphonate | Vertebral Fractures | Hip Fractures |
|---|---|---|
| Alendronate | 44-48% (1-6) | 51-59% (2,7) |
| Risedronate | 41-50% (8-11) | 40-60% (10) |
| Ibandronate | 50-62% (12,13) | Not significant* |
| Zoledronic acid | 70% (14) | 41% (14) |
*The study group had fairly high T scores (mean total hip and femoral neck T-scores were -1.7 and-2.0, respectively). A subgroup analysis showed that in individuals with T scores <-3.0 had nonvertebral fracture reduction by 69%.
- Cummings SR, Black DM, Thompson DE, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 1998; 280: 2077-82.
- Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC et al. Randomized trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 1996; 348: 1535-41.
- Ensrud KE, Black DM, Palermo L, Bauer C, Barrett-Connor E, Quandt SA et al. Treatment with alendronate prevents fractures in women at highest risk. Arch Intern Med 1997; 157: 2617-2624.
- Liberman UA, Weiss SR, Broll J, Minne HW, Quan H, Bell NH, et al. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. N Eng J Med 1995; 333: 1437-43.
- Pols HA, Felsenberg D, Hanley DA, Stepan J, Monoz-Torres M, Wilkins TJ, et al. Multinational, placebo-controlled randomized trial of the effects of alendronate on bone density and fracture risk in postmenopausal women with low bone mass: Results of the FOSIT study. Osteoporos Int 1999; 9: 461-468.
- Cranney A, Wells G, Willan A, et al. Meta-analyses of therapies for postmenopausal osteoporosis II. Endocr Rev 2002; 23: 508-516.
- Black CM, Thompson DE, Bauer DC, et al. Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention trial. FIT Research Group. J Clin Endocrinol Metab 2000; 85: 4118-4124.
- Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T et al. Effects of risedronate treatment on vertebral and non-vertebral fractures in women with postmenopausal osteoporosis. JAMA 1999; 282: 1344-1352.
- Reginster JY, Minne HW, Sorensen OH, Hooper M, Roux C, et al. Randomized trial of the effects of risedronate on vertebral fractures in women with established osteoporosis. Osteoporos Int 2000; 11: 83-91.
- McClung MR, Geusen P, Miller PD, Zippel H, Bensen WG, Roux C, et al. Effect of risedronate on the risk of hip fracture in elderly women. N Engl J Med 2001; 344: 333-40.
- Sorensen OH, Crawford GM, Mulder H, et al. Long term efficacy of risedronate: a 5-year placebo-controlled clinical experience. Bone 2003; 23: 120-126.
- Delmas PD, Recker RR, Chestnutt 3rd CH, et al. Daily and intermittent oral ibandronate normalize bone turnover and provide significant reduction in vertebral fracture risk: results from the BONE study. Osteoporos Int 2004; 15: 792-798.
- Chesnutt 3rd CH, Skag A, Christiansen C, et al. Oral Ibandronate Osteoporosis Vertebral Fracture Trial in North America and Europe (BONE). Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res 2004; 19: 1241-1249.
- Black DM, Delmas PD, Eastell R, Reid IR, et al. Once-Yearly Zoledronic Acid for Treatment of Postmenopausal Osteoporosis. NEJM 2007; 356: 1809-1822.