Treatment with
alendronate, a potent and specific inhibitor of
bone resorption, is known to significantly reduce fracture risk among women with
postmenopausal osteoporosis. The purpose of this meta-analysis was to assess the consistency of the effect of
alendronate in reducing the risk of hip fracture among different studies and populations. Data from completed, randomized, treatment studies were pooled in a meta-analysis. The duration of the studies ranged from 1-4.5 years. The dose of
alendronate ranged from 5-20 mg/day, with over 95% of patients receiving either 5 or 10 mg/day during the trials. In patients with a T-score of less than or equal to -2.0, or with a vertebral fracture, the effect on hip fracture risk consistently favored patients receiving
alendronate therapy, with an overall reduction in risk of hip fracture of 45% [95% confidence interval (CI) 16% to 64%, P=0.007]. For patients who met the criteria of
osteoporosis, as defined by the World Health Organization (WHO), the overall risk reduction was 55% (95% CI 29% to 72%, P=0.0008). In both analyses we performed a sensitivity analysis by removing one study at a time. The strength of the evidence was not dependent on any one study. We conclude that
therapy with
alendronate is associated with significant and clinically important reductions in the incidence of hip fracture in women with
postmenopausal osteoporosis. The overall reduction is consistent among different patient populations.