Study looks at predicting fracture risk after women stop bisphosphonate therapy

Age and testing of hip bone mineral density (BDM) when postmenopausal women discontinue bisphosphonate therapy can help predict the likelihood of fractures over the next five years.

Bisphosphonates can reduce the risk of hip and . But recent concerns about safety issues, including osteonecrosis of the jaw, atypical femoral and esophageal cancer, have increased interest in interrupting or stopping bisphosphonate therapy after several years of treatment. This study tested methods for predicting by measuring BMD using hip and spine duel-energy x-ray absorptiometry (DXA) and also (BTMs) when women discontinue bisphosphonate therapy and a few years afterward.

The Fracture Intervention Trial Long-term Extension (FLEX) randomly assigned (ages 61 to 86 years) previously treated with the alendronate sodium (for four to five years) to five additional years of alendronate or placebo from 1998 through 2003. This analysis included only the placebo group. Hip and spine DXA were measured when the placebo was started and after one to three years of follow-up. Two different BTMs also were measured at baseline and after one and three years.

During five years of placebo, 22 percent of women (94 of 437) had one or more fractures; 82 had fractures after one year. Older age and lower hip BMD at the time alendronate therapy was discontinued were associated with higher rates of clinical fractures during the subsequent five years. However, neither BMD measures after one-year nor BTM levels one- to two -years after discontinuing alendronate were associated with fracture risk.

"Women with greater total hip bone loss two or three years after discontinuation may be at increased risk of fracture, but these results need to be confirmed in other studies before routine measurement of BMD after discontinuation of alendronate therapy can be recommended. … In the meantime, short-term monitoring with BMD, BAP or NTX [two bone turnover markers] after discontinuation of four to five years of alendronate therapy does not appear to improve fracture prediction," Douglas C. Bauer, M.D., of the University of California, San Francisco, and colleagues wrote in their today's JAMA Internal Medicine article.

More information: JAMA Intern Med. Published online May 5, 2014. DOI: 10.1001/jamainternmed.2014.1232

add to favorites email to friend print save as pdf

Related Stories

Alendronate reduces adjacent-level vertebral fractures

Dec 30, 2013

(HealthDay)—For females with osteoporosis, the rate of adjacent-level vertebral fractures is relatively low, with reduced odds with bisphosphonate therapy, according to a study published in the Dec. 1 issue ...

Recommended for you

Second bird flu case confirmed in Canada

8 hours ago

The husband of a Canadian who was diagnosed earlier this week with bird flu after returning from a trip to China has also tested positive for the virus, health officials said Friday.

What exactly is coronavirus?

14 hours ago

The conflicts in Syria and Iraq are straining public health systems and public health efforts meant to prevent and detect the spread of infectious diseases. This is generating a "perfect storm" of conditions for outbreaks. Among the infections raising concern is Middle East Respiratory Syndrome, caused by a type of coronavirus, which emerged in 2012. ...

Scientists find Ebola virus is mutating

15 hours ago

(Medical Xpress)—Researchers working at Institut Pasteur in France have found that the Ebola virus is mutating "a lot" causing concern in the African countries where the virus has killed over eight thous ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.