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Duration of Preventive Therapy for Menopausal Bone Loss
Alendronate can prevent menopausal bone loss and fractures, but long-term efficacy and optimal duration of use are unknown. In this international study supported by the manufacturer of alendronate, researchers randomized 1609 postmenopausal women, 10 percent of whom had osteoporosis, to 5 mg or 2.5 mg daily of alendronate, placebo, or open-label estrogen-progestin (estrogen-medroxyprogesterone or estradiol-norethisterone). After 2 years of treatment, half of the alendronate group was switched to placebo.
After 4 years, the 5-mg alendronate group had increases in spine, hip, and total-body bone mineral density (BMD), and stable forearm BMD. The 2.5-mg group had similar, though less pronounced, increases. Hormone replacement and alendronate yielded similar results, except that estradiol-norethisterone was significantly more effective in increasing total-body BMD, and both hormone preparations were more effective at the forearm. Subjects who switched from alendronate to placebo had significant losses after the switch (unlike those who continued alendronate), although their BMD remained greater than that of those who received placebo for the entire study.
Comment: Many menopausal women and their physicians are asking which preventive treatment is best and how long it must be continued to derive benefit with minimal risk. Although this study cannot answer these broader questions, it can help inform decisions. First, hormone replacement seems more effective than alendronate for increasing BMD. Second, with alendronate, BMD gains are maintained or increased over 4 years of use, and 2-year gains are nearly all lost after 2 years off the drug.
— R Saitz
Published in Journal Watch General Medicine January 18, 2000
Citation(s):
Ravn P et al. Alendronate and estrogen-progestin in the long-term prevention of bone loss: Four-year results from the early postmenopausal intervention cohort study: A randomized trial. Ann Intern Med 1999 Dec 21 131 935-942.
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