Does a History of Non-Vertebral Fracture Identify Women Without Osteoporosis for Treatment?
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- Ryder, K.M., Cummings, S.R., Palermo, L. et al. J GEN INTERN MED (2008) 23: 1177. doi:10.1007/s11606-008-0622-0
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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.
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).
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.