|November 2007 · Vol. 19, No. 11
HOW DEVELOPMENTS ARE CHANGING PATIENT CARE
Recent data refine our understanding of how to use key drugs, particularly bisphosphonates, zoledronic acid, recombinant PTH, and raloxifene
Women using risedronate had an incidence of hip fracture 43% lower than those using alendronate
In women with a history of hip fracture, new clinical fractures occurred in 8.6% of those using zoledronic acid and 13.9% of those taking placebo
Women with a previous fracture, and those at high risk for spine fracture, should probably not take a holiday from alendronate
Dr. Goldstein is Professor of Obstetrics and Gynecology at New York University School of Medicine in New York City. He is also Director of Gynecologic Ultrasound and Co-Director of Bone Densitometry at New York University Medical Center.
The author is a consultant to Pfizer, Eli Lilly, GlaxoSmithKline, Merck, Upsher-Smith, and Procter & Gamble.
As 2007 draws to a close, we are still awaiting the World Health Organization’s fracture risk-assessment tool. The much-anticipated instrument will calculate 5- and 10-year fracture risks using an individual’s femoral neck T-score, age, history of low-trauma fracture, body mass index, steroid exposure, family history of hip fracture, smoking status, and alcohol intake. Once it is implemented, the tool will eliminate much of the confusion that arises when the T-score is the only variable used to determine the need for pharmacotherapy.
Why is the ability to stratify risk important? Although the incidence of fragility fractures is highest in osteoporotic women (as defined by the T-score), the absolute number of fractures is greater in those who have osteopenia. All clinicians should realize that the current definitions of normal bone density, osteopenia, and osteoporosis apply to the postmenopausal population only: