Does a History of Non-Vertebral Fracture Identify Women Without Osteoporosis for Treatment?

  • Kathryn M. Ryder
  • Steven R. Cummings
  • Lisa Palermo
  • Suzanne Satterfield
  • Douglas C. Bauer
  • Adrianne C. Feldstein
  • John T. Schousboe
  • Ann V. Schwartz
  • Kristine Ensrud
  • for the Fracture Intervention Trial Research Group
Original Article

DOI: 10.1007/s11606-008-0622-0

Cite this article as:
Ryder, K.M., Cummings, S.R., Palermo, L. et al. J GEN INTERN MED (2008) 23: 1177. doi:10.1007/s11606-008-0622-0

Abstract

Background

Postmenopausal women with a prior fracture have an increased risk for future fracture. Whether a history of non-vertebral fracture defines a group of women with low bone mass but without osteoporosis for whom alendronate would prevent new non-vertebral fracture is not known.

Subjects and Methods

Secondary analysis of data from the Fracture Intervention Trial (FIT). Of 2,785 postmenopausal women with a T-score at the femoral neck between −1 and −2.5 and without prevalent radiographic vertebral deformity, 880 (31.6%) reported experiencing a fracture after 45 years of age. Women were randomized to placebo or alendronate (5 mg/day years for the first 2 years and 10 mg/day thereafter) and were followed for an average of 4.2 ± 0.5 years. Incident non-vertebral fractures were confirmed by x-rays and radiology reports.

Results

In the placebo arm, a self-report of prior fracture identified women with a 1.5-fold (hazard ratio [RH] 1.46, 95% C.I. 1.04–2.04) increased risk for incident non-vertebral fracture. However, there was no evidence that the effect of alendronate differed across subgroups of women with (RH 1.26 for alendronate vs placebo, 95% C.I. 0.89–1.79) and without prior fracture (RH 1.02 for alendronate vs placebo, 95% C.I. 0.76–1.38; P = 0.37 for interaction).

Conclusion

Assessing a clinical risk factor, prior non-vertebral fracture, did not identify women with low bone mass for whom alendronate reduced future non-vertebral fracture risk.

KEY WORDS

fracture women osteoporosis 

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Kathryn M. Ryder
    • 2
    • 9
  • Steven R. Cummings
    • 3
  • Lisa Palermo
    • 3
  • Suzanne Satterfield
    • 1
    • 2
  • Douglas C. Bauer
    • 3
    • 4
  • Adrianne C. Feldstein
    • 5
  • John T. Schousboe
    • 6
  • Ann V. Schwartz
    • 3
  • Kristine Ensrud
    • 7
    • 8
  • for the Fracture Intervention Trial Research Group
  1. 1.The Department of MedicineThe University of Tennessee Health Science CenterMemphisUSA
  2. 2.Department of Preventive MedicineThe University of Tennessee Health Science CenterMemphisUSA
  3. 3.The Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoUSA
  4. 4.The Department of MedicineUniversity of California, San FranciscoSan FranciscoUSA
  5. 5.The Center for Health ResearchKaiser Permanente NorthwestPortlandUSA
  6. 6.Division of Health Policy and Management, University of MinnesotaThe Park Nicollet Health ServicesMinneapolisUSA
  7. 7.The Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical CenterUniversity of MinnesotaMinneapolisUSA
  8. 8.Department of Medicine and Division of Epidemiology and Community HealthUniversity of MinnesotaMinneapolisUSA
  9. 9.Division of General Internal MedicineDepartment of MedicineMemphisUSA

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