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Changes in bone density and turnover after alendronate or estrogen withdrawal
Richard D Wasnich1, Yu Z Bagger, David J Hosking
1Radiant Research-Honolulu, Honolulu, HI 96814, USA. richardwasnich@radiantresearch.com
Menopause (New York, N.Y.)
|November 17, 2004
Summary
Discontinuation of alendronate (bone mineral density medication) resulted in smaller bone density losses than stopping estrogen-progestin therapy in postmenopausal women. Alendronate offers greater residual skeletal benefits after treatment cessation.
Area of Science:
- Endocrinology
- Bone Metabolism
- Pharmacology
Background:
- Postmenopausal osteoporosis is a significant health concern.
- Hormone replacement therapy (HRT) and bisphosphonates are common treatments.
- Understanding bone changes after treatment withdrawal is crucial for long-term management.
Purpose of the Study:
- To compare bone mineral density (BMD) and bone turnover markers after discontinuing alendronate versus estrogen-progestin therapy.
- To evaluate the residual skeletal effects of these treatments in postmenopausal women.
Main Methods:
- A randomized, blinded, multinational, placebo-controlled trial involving 1,609 postmenopausal women (ages 45-59).
- Participants received alendronate, placebo, or estrogen-progestin for 4 years.
- Subgroups switched from alendronate to placebo or followed off estrogen-progestin for 2 additional years.
- Bone mineral density (lumbar spine and hip) and bone turnover markers were assessed.
Main Results:
- Both alendronate and estrogen-progestin increased BMD in the first 4 years.
- After 4 years, women discontinuing alendronate showed smaller BMD decreases (-2.42% spine, -1.09% hip) compared to those discontinuing estrogen-progestin (-7.69% spine, -5.16% hip).
- Placebo group experienced steady BMD decline throughout the 6 years.
Conclusions:
- Alendronate demonstrates superior residual skeletal benefits compared to estrogen-progestin after treatment discontinuation.
- These findings have implications for long-term osteoporosis management strategies.