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Alendronate for fracture prevention in postmenopause
Kathryn K Holder1, Sara Shelton Kerley
1David Grant Medical Center, Family Medicine Residency Program, Travis AFB, California, USA. kathryn.holder-02@travis.af.mil
American Family Physician
|September 16, 2008
Summary
Alendronate significantly reduces fracture risk in postmenopausal women, particularly for secondary prevention of vertebral, hip, and wrist fractures. While effective for vertebral fracture prevention in primary cases, overall primary prevention benefits were less pronounced.
Area of Science:
- Osteoporosis Research
- Pharmacological Interventions
- Geriatric Medicine
Background:
- Osteoporosis is characterized by reduced bone mass and deterioration, increasing fracture risk.
- Alendronate, a bisphosphonate, inhibits osteoclast activity to reduce bone resorption.
Purpose of the Study:
- To evaluate the efficacy of alendronate in preventing osteoporotic fractures in postmenopausal women.
- Assessed both primary and secondary prevention strategies.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) from 1966-2007.
- Included 11 trials with 12,068 participants; data abstraction and analysis were performed in duplicate.
- Assessed study quality based on allocation concealment, blinding, and withdrawals.
Main Results:
- Alendronate (10 mg/day) significantly reduced vertebral fractures in both primary (45% RR reduction) and secondary (45% RR reduction) prevention.
- Significant reductions in nonvertebral (23% RR), hip (53% RR), and wrist (50% RR) fractures were observed for secondary prevention only.
- No statistically significant increase in adverse events was found in RCTs, though observational data suggest risks for upper gastrointestinal injury and osteonecrosis of the jaw.
Conclusions:
- Alendronate at 10 mg/day demonstrates significant benefits for secondary prevention of major osteoporotic fractures.
- Clinically important reductions in vertebral fractures were noted for primary prevention.
- While effective, potential gastrointestinal and jaw-related adverse events warrant consideration.
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