Men's Osteoporosis Support Group

Intravenous Zoledronate and Oral Alendronate after low-trauma fracture

Intern Med J. 2010 Feb 26. [Epub ahead of print]. Intravenous Zoledronate and Oral Alendronate in Patients with a Low Trauma Fracture- experience from an osteoporosis clinic. Craig SJ and others. PMID: 20214696. There has been a major issue getting people to take their oral bisphosphonate osteoporosis medications, such as alendronate (ALN) (Fosamax). This study did a head-to-head comparison between once-weekly, 70-mg Fosamax and once-yearly 4-mg intravenous zoledronic acid (ZOL) (Reclast 5 mg in the U.S.). The 12-month study included 169 patients with a low trauma fracture and reduced bone mineral density (BMD). The results showed no significant difference in the improvement in BMD of the lumbar spine or hip between groups. The ZOL group was significantly older, had more men and there were significantly more new fractures (p<0.001) in the ZOL group (7.2%) vs. the ALN group (1%). The authors concluded, "ZOL and ALN both produce a significant increase in BMD and are well tolerated in patients with osteoporotic, low trauma fractures. Yearly ZOL provides a safe, convenient alternative to weekly oral bisphosphonates."

Editor's comments. For those who have a hard time making themselves take a pill once a week, this study offers another option: once-yearly injections of zoledronic acid that provides the same increase in BMD. What is interesting is the much higher fracture rate in the ZOL group, with virtually equal increases in BMD. I don't have the full article so I have to guess at the reasons for the difference. But the fact that the ZOL group was significantly older would tend to be a likely candidate for the reason. Studies have shown that BMD is not the only factor affecting fracture risk. Particularly age, with the greater tendency to fall, may account for that.

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