Zoledronate Effective in Fracture Protection for Women with Osteopenia

Postmenopausal osteopenia patients may reduce their risk of fracture with zoledronate, according to new research. 

The six-year, double-blind trial included 2,000 female osteopenia patients (defined by a T score of −1.0 to −2.5 at either the total hip or the femoral neck on either side) (mean age at baseline, 71 years). Every 18 months, participants received either a 5 mg dose of zoledronate (zoledronate group) or normal saline (placebo group). A daily 1 g dose of calcium was recommended but not administered by researchers, and women not already taking vitamin D supplements were given a single 2.5 mg dose of cholecalciferol prior to the trial and 1.25 mg every month during the trial. 

Original Article: Fracture Prevention with Zoledronate in Older Women with Osteopenia https://t.co/m7frf8EEKT

Editorial: A Not-So-New Treatment for Old Bones https://t.co/xoB4dfElJt#ASBMR2018 pic.twitter.com/PVY2BNjcdK

— NEJM (@NEJM) October 1, 2018

One hundred ninety women in the placebo group sustained a fragility fracture, compared to 122 in the zoledronate group (hazard ratio [HR] with zoledronate, 0.63; 95% confidence interval, 0.50 to 0.79; P < 0.001). The zoledronate group had decreased odds of nonvertebral fragility fractures (HR, 0.66; P = 0.001), symptomatic fractures (hazard ratio, 0.73; P = 0.003), vertebral fractures (odds ratio, 0.45; P = 0.002), and height loss (P < 0.001). 

Most fragility fractures occur in postmenopausal women with osteopenia. In @NEJM: zoledronic acid every 18 months reduces the risk of fragility fractures and height loss. No cases of osteonecrosis of the jaw or atypical femoral fractures.https://t.co/sFOgU1Eggx pic.twitter.com/zhmi0uN18U

— Joy Wu, MD, PhD 黃以佳 (@JoyYWu) October 1, 2018

The study appeared in the New England Journal of Medicine and presented at the annual meeting of the American Society for Bone and Mineral Research. 

The researchers pointed out that most previous studies have focused on osteoporosis, not osteopenia, patients. 

“However, treating only patients who have osteoporosis has only a limited capacity to decrease total numbers of fractures, since fractures tend to occur in the much larger group of women whose bone mineral density is in the osteopenic range,” they wrote. 

https://twitter.com/Dr_BoAbrahamsen/status/1046790726292525056

The study’s findings only apply to a certain population and should not be applied across the board, the authors also said. 

“Our trial involved only women who were 65 years of age or older and had hip bone mineral density that was characterized as osteopenia, so our findings should not be extrapolated to younger women, men, or persons who have normal bone mineral density,” they wrote. 

The study authors concluded, “The risk of nonvertebral or vertebral fragility fractures was significantly lower in women with osteopenia who received zoledronate than in women who received placebo.” 

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Sources: NEJM, Rheumatology News