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Improvement in spine bone density and reduction in risk of vertebral fractures during treatment with antiresorptive drugs - 02/09/11

Doi : 10.1016/S0002-9343(01)01124-X 
Steven R. Cummings, MD a, ⁎, David B. Karpf, MD c, d, Fran Harris, MS b, Harry K. Genant, MD e, Kristine Ensrud, MD, MPH f, g, Andrea Z. LaCroix, PhD h, Dennis M. Black, PhD b
a Department of Medicine (SRC), University of California, San Francisco, California, USA 
b Department of Epidemiology and Biostatistics (FH, DMB), University of California, San Francisco, California, USA 
c Geron Corporation (DBF), Menlo Park, California, USA 
d Department of Medicine (DBK), Stanford University School of Medicine, Palo Alto, California, USA 
e Department of Radiology (HKG), University of California, San Francisco, California, USA 
f Center for Chronic Disease Outcomes Research (KE), Veteran’s Administration Hospital, Minneapolis, Minnesota, USA 
g Departments of Medicine and Epidemiology (KE), University of Minnesota, Minneapolis, Minnesota, USA 
h Department of Epidemiology (AZL), University of Washington, Seattle, Washington, USA 

*Requests for reprints should be addressed to Steven R. Cummings, MD, Prevention Sciences Group, 74 New Montgomery Street, Suite 600, San Francisco, California 94105, USA

Abstract

Purpose

To estimate how much the improvement in bone mass accounts for the reduction in risk of vertebral fracture that has been observed in randomized trials of antiresorptive treatments for osteoporosis.

Methods

After a systematic search, we conducted a meta-analysis of 12 trials to describe the relation between improvement in spine bone mineral density and reduction in risk of vertebral fracture in postmenopausal women. We also used logistic models to estimate the proportion of the reduction in risk of vertebral fracture observed with alendronate in the Fracture Intervention Trial that was due to improvement in bone mineral density.

Results

Across the 12 trials, a 1% improvement in spine bone mineral density was associated with a 0.03 decrease (95% confidence interval [CI]: 0.02 to 0.05) in the relative risk (RR) of vertebral fracture. The reductions in risk were greater than predicted from improvement in bone mineral density; for example, the model estimated that treatments predicted to reduce fracture risk by 20% (RR = 0.80), based on improvement in bone mineral density, actually reduce the risk of fracture by about 45% (RR = 0.55). In the Fracture Intervention Trial, improvement in spine bone mineral density explained 16% (95% CI: 11% to 27%) of the reduction in the risk of vertebral fracture with alendronate.

Conclusion

Improvement in spine bone mineral density during treatment with antiresorptive drugs accounts for a predictable but small part of the observed reduction in the risk of vertebral fracture.

El texto completo de este artículo está disponible en PDF.

Keywords : Bone mineral density, Osteoporosis, Alendronate, Meta-analysis, Estrogen therapy, Calcitonin, Etidronate, Raloxifene, Vertebral fractures, Surrogate markers, Randomized trials


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Vol 112 - N° 4

P. 281-289 - mars 2002 Regresar al número
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