Sustained vertebral antifracture efficacy of oral anti-osteoporotic therapies in postmenopausal osteoporosis.

Abstract

OBJECTIVE:

Vertebral fractures are common in women with postmenopausal osteoporosis, a chronic condition requiring long-term treatment with anti-osteoporotic treatments. Therefore, it is important to assess sustainability of antifracture efficacy.

METHODS:

A review of the literature to determine pivotal vertebral fracture studies for oral bisphosphonates (ibandronate, risedronate and alendronate), strontium ranelate, and raloxifene and to evaluate vertebral antifracture efficacy over time.

RESULTS:

Data from the BONE trial showed that ibandronate sustained vertebral antifracture efficacy over time (58% vertebral fracture risk reduction in first year p = 0.0561, increased to 62% for years 0-3; p < 0.001). The Vertebral Efficacy with Risedronate Therapy-North America (VERT-NA) and VERT-multi-national (VERT-MN) studies demonstrated that the relative risk reduction (RRR) with risedronate versus placebo decreased over time (VERT-NA: 65% for first year to 41% for years 0-3; VERT-MN: 61% for first year to 49% for years 0-3). Data from the Fracture Intervention Trial (FIT) I trial with alendronate showed that the RRR in the cumulative incidence of new vertebral fractures versus placebo decreased from 62% for years 0-2 to 47% for years 0-3. Similar decreases in RRR over time were reported with strontium ranelate in the Spinal Osteoporosis Therapeutic Intervention study (SOTI; 49% for first year to 33% for years 0-4) and Treatment of Peripheral Osteoporosis Study (TROPOS; 45% for first year to 24% for years 0-5). No clear trend exists for sustained efficacy over time with raloxifene.

CONCLUSIONS:

Vertebral fracture protection could be interpreted to decrease over time with alendronate, risedronate and strontium ranelate, and may be due to multiple factors. Ibandronate sustained vertebral antifracture efficacy over time.

• Authors: M-L Brandi
• Journal: Current medical research and opinion (Curr Med Res Opin) Vol. 26 Issue 11 Pg. 2553-63 (Nov 2010) ISSN: 1473-4877 [Electronic] England
• PMID: 20858031 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Bone Density Conservation Agents
• Diphosphonates
• Organometallic Compounds
• Thiophenes
• strontium ranelate
• Raloxifene Hydrochloride

Topics

• Aged
• Bone Density Conservation Agents (administration & dosage, pharmacology, therapeutic use)
• Cervical Vertebrae (injuries)
• Diphosphonates (administration & dosage, pharmacology)
• Female
• Fractures, Bone (prevention & control)
• Humans
• Middle Aged
• Organometallic Compounds (administration & dosage, pharmacology, therapeutic use)
• Osteoporosis, Postmenopausal (drug therapy)
• Raloxifene Hydrochloride (administration & dosage, pharmacology, therapeutic use)
• Thiophenes (administration & dosage, pharmacology, therapeutic use)
• Treatment Outcome