90, No. 3 1294 - 1301 Severely Suppressed Bone Turnover: A Potential Complication
of Alendronate Therapy Clarita V. Odvina, Joseph E. Zerwekh, D. Sudhaker Rao, Naim Maalouf, Frank A. Gottschalk and Charles Y. C. Pak
Not exact matches
From a base group
of over 400,000 elderly patients, 1802 were prescribed
alendronate after starting treatment with the cortisone preparation prednisolone in tablet form.
The group with matched controls, which also consisted
of 1802 people, took prednisolone tablets, but did not receive the protective
alendronate treatment.
Doctors commonly treat hyperparathyroidism using a class
of prescription drugs called bisphosphonates, including
alendronate (marketed under the brand name Fosamax) and ibandronate (Boniva), which are supposed to strengthen bones.
The investigated cohort consisted
of 1802 patients with oral prednisolone and
alendronate treatment and 1802 matched controls, selected from 6076 patients with oral prednisolone but without
alendronate treatment (Figure 1 and Figure 2).
In an unadjusted Cox model,
alendronate treatment was associated with lower
of risk
of hip fracture (hazard ratio [HR], 0.35; 95 % CI, 0.23 - 0.55), and the risk estimate did not substantially change in multivariable - adjusted Cox models (Table 2 and Figure 3).
Alendronate treatment was not associated with increased risk of mild upper gastrointestinal tract symptoms (alendronate vs no alendronate, 15.6 [95 % CI, 11.6 - 21.0] vs 12.9 [95 % CI, 9.3 - 18.0] per 1000 person - years; P =.40) or peptic ulcers (10.9 [95 % CI, 7.7 - 15.5] vs 11.4 [95 % CI, 8.0 - 16.2] per 1000 person - year
Alendronate treatment was not associated with increased risk
of mild upper gastrointestinal tract symptoms (
alendronate vs no alendronate, 15.6 [95 % CI, 11.6 - 21.0] vs 12.9 [95 % CI, 9.3 - 18.0] per 1000 person - years; P =.40) or peptic ulcers (10.9 [95 % CI, 7.7 - 15.5] vs 11.4 [95 % CI, 8.0 - 16.2] per 1000 person - year
alendronate vs no
alendronate, 15.6 [95 % CI, 11.6 - 21.0] vs 12.9 [95 % CI, 9.3 - 18.0] per 1000 person - years; P =.40) or peptic ulcers (10.9 [95 % CI, 7.7 - 15.5] vs 11.4 [95 % CI, 8.0 - 16.2] per 1000 person - year
alendronate, 15.6 [95 % CI, 11.6 - 21.0] vs 12.9 [95 % CI, 9.3 - 18.0] per 1000 person - years; P =.40) or peptic ulcers (10.9 [95 % CI, 7.7 - 15.5] vs 11.4 [95 % CI, 8.0 - 16.2] per 1000 person - years; P =.86).
Among the 3604 patients using prednisolone, there was no difference in medication possession ratio
of acetylsalicylic acid (analysis
of healthy adherer effect)(eFigure 3 in the Supplement; P =.91) between patients with or without
alendronate treatment.
After a median follow - up
of 1.32 years (interquartile range, 0.57 - 2.34 years), there were 27 hip fractures in the
alendronate group and 73 in the no -
alendronate group, corresponding to incidence rates
of 9.5 (95 % CI, 6.5 - 13.9) and 27.2 (95 % CI, 21.6 - 34.2) fractures per 1000 person - years, with an absolute rate difference
of − 17.6 (95 % CI, − 24.8 to − 10.4).
The median
alendronate medication possession ratio since prednisolone treatment start was 88 % and the median time delay from start
of prednisolone to
alendronate initiation was 3.9 (interquartile range, 0.5 - 20.0) months.
There were 27 hip fractures in the
alendronate group and 73 in the
alendronate - untreated group, corresponding to incidence rates
of 9.5 (95 % CI, 6.5 - 13.9) and 27.2 (95 % CI, 21.6 - 34.2) fractures per 1000 person - years, with an absolute rate difference
of − 17.6 (95 % CI, — 24.8 to — 10.4)(Table 2).
The researchers created a hybrid compound from 2 molecules: LLP2A, a protein - like molecule that sticks to α4β1 integrins, and
alendronate, an osteoporosis drug that sticks to the outer surface
of bones.
What the
alendronate drugs do is by stopping the normal breakdown
of bones, they favor the buildup
of old bone that becomes brittle over time and becomes so hard and dense that the normal blood supply can not get into the bone.
This study evaluated the effectiveness
of Fosamax (
alendronate) as a palliative therapy for osteosarcoma in Irish Wolfhounds.
Fosamax is the brand name for
alendronate, a type
of bisphosphonate drug that is manufactured by Merck & Co..
The women taking bisphosphonates, namely Fosamax (
alendronate), had a 32 percent reduction in their rate
of invasive breast cancer compared to women who were not taking one
of these drugs.