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Alendronate increases BMD at appendicular and axial skeletons in patients with established osteoporosis
Journal of Orthopaedic Surgery and Research
Alendronate increases BMD at appendicular and axial skeletons in patients with established osteoporosis
Ling Qin 0 1
Wingyee Choy 1
Szeki Au 0
Musei Fan 0
Pingchung Leung 0 1
0 Hong Kong Jockey Club Center for Osteoporosis Care and Control, The Chinese University of Hong Kong , Hong Kong SAR , China
1 Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong , Hong Kong SAR , China
Background: To identify high-risk patients and provide pharmacological treatment is one of the effective approaches in prevention of osteoporotic fractures. This study investigated the effect of 12-month Alendronate treatment on bone mineral density (BMD) and bone turnover biochemical markers in postmenopausal women with one or more non-traumatic fractures, i.e. patients with established osteoporosis. Methods: A total of 118 Hong Kong postmenopausal Chinese women aged 50 to 75 with lowenergy fracture at distal radius (Colles' fracture) were recruited for BMD measurement at lumbar spine and non-dominant hip using Dual-Energy X-ray Absorptiometry (DXA). 47 women with BMD T-score below -2 SD at either side were identified as patients with established osteoporosis and then randomized into Alendronate group (n = 22) and placebo control group (n = 25) for BMD measurement at spine and hip using DXA and distal radius of the non-fracture side by peripheral quantitative computed tomography (pQCT), and bone turnover markers, including bone forming alkaline phosphatase (BALP) and bone resorbing urinary Deoxypyridinoline (DPD). All measurements were repeated at 6 and 12 months. Results: Alendronate treatment significantly increased BMD, more in weight-bearing skeletons (5.1% at spine and 2.5% at hip) than in non-weight bearing skeleton (0.9% at distal radius) after 12 months treatment. Spine T-score was significant improved in Alendronate group (p < 0.01) (from -2.2 to -1.9) but not in control placebo group. The Alendronate treatment effect was explained by significant suppression of bone turnover. Conclusion: 12 months Alendronate treatment was effective to increase BMD at both axial and appendicular skeletons in postmenopausal women with established osteoporosis.
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Background
Our recent retrospective study shows that
postmenopausal women with low-energy Colles' fractures are
associated with osteoporosis [1]. Similar studies are also
reported before that osteoporotic fracture is often seen in
high risk patients such as those with established
osteoporosis, i.e. osteoporotic patients with one or more
lowenergy fractures [2-4]. Osteoporotic fracture incurs high
morbidity, mortality and healthcare expenditure [3,5-7].
The current consensus for effective prevention of
osteoporotic fracture is to identify the high-risk patients and
put them on effective pharmacological intervention
programs.
Anti-resorptive drugs such as Bisphosphonates have been
proven to be effective for treatment of osteoporosis and
fracture prevention in patients with osteoporosis [7-10].
The aim of this study was to evaluate effects of 12-month
Alendronate treatment in postmenopausal women with
established osteoporosis. Bone mineral density (BMD)
was used as the end-point and bone turnover biochemical
markers were evaluated for monitoring bone metabolism
in response to drug treatment effects.
Methods
In order to confirm our treatment effects, we identified
patients with established osteoporosis for treatment and
used bone mineral density (BMD) at both axial and
appendicular skeletons as the end-point for evaluations.
Subject recruitment and identification of patients with
established osteoporosis
One hundred eighteen postmenopausal women, aged
5075 with one low-energy fracture at distal radius
(Colles' fracture) in the past 5 years, were concurrently
recruited form the hospital of the investigators as
described in our recent study [1]. Each author certifies that
his or her institution has approved the human protocol
for this investigation and that all investigations were
conducted in conformity with ethical principles of research,
and that informed consent was obtained. Exclusion
criteria were women under hormonal replacement therapy or
drug treatment known to affect bone metabolism, with
condition such as hypo- or hyperparathyroidism and
hypo- or hyperthyroidism, renal or liver disease. In order
to avoid the possible adverse effect of Alendronate on
gastrointestinal tract, women with history of gastrointestinal
tract disease or chronic stomach disease were also
excluded [8,9]. All subjects had BMD measurement at
lumbar spine (L2-L4) and non-dominant hip (femoral
neck) by Dual-Energy X-ray Absorptiometry (DXA)
(Norland XR36, Norland Corporation, Fort Atkinson, WI,
USA). Patients with established osteoporosis were those
found to have T-score below -2 SD at spine or hip [1,6,11].
Finally, a total of around 40%, i.e. 47 subjects were
identified and recruited as patients with established
osteoporosis (...truncated)