The Findings of Bone Mineral Densitometry Following Preventive Treatment with Alendronate in Menopausal Women with Osteopenia; What is the Best Dose?

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 General Practitioner, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Rheumatology Research Center of Tehran University, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background: Osteoporosis is the most common metabolic bone disease worldwide that is defined by lessened bone density. Osteoporosis progression is accompanied with increased risk of pathologic fractures. Osteopenia is attributed to the first steps of bone density loss process. Studies about treatment initiation while osteopenia is presented, and the treatment dose, are controversial. In this study, low dose versus high dose of alendronate among menopausal women with osteopenia was evaluated.Methods: The current randomized clinical trial (RCT) study was conducted on 152 menopausal women with osteopenia referred to a rheumatology clinic during 2017-18. Patients were randomly divided into two groups of treatment with weekly doses of 35 mg and 70 mg alendronate, and then followed for two years. Bone mineral densitometry (BMD) was performed for all the patients prior to and after treatment, and findings were compared.Findings: Two assessed groups were not statistically different regarding age, gender, height, weight, and body mass index (BMD) (P > 0.050 for all). BMD findings of two groups including hip and spine/wrist Fracture risk assessment system (FRAX), hip and spine T-score, and hip and spine Z-score significantly improved following two years (P < 0.001); but the comparison of two doses presented no statistical difference considering BMD findings improvement (P > 0.050).Conclusion: Findings of this study are in favor of preventive treatment with alendronate in women with osteopenia. Furthermore, considering digestive irritability as the main complaint of alendronate, based on our findings, weekly 35 mg use of this agent can be considered.

Keywords

References

  1. Brewer L, Williams D, Moore A. Current and future treatment options in osteoporosis. Eur J Clin Pharmacol 2011; 67(4): 321-31.
  2. Aghaei Meybodi H, Heshmat R, Maasoumi Z, Soltani A, Hosseinnezhad A, Keshtkar A, et al. Iranian Osteoporosis Research Network: Background, mission and its role in osteoporosis management. Iran J Public Health 2008; 37(Supple 2): 1-6.
  3. Hasegawa Y, Suzuki S, Wingstrand H. Risk of mortality following hip fracture in Japan. J Orthop Sci 2007; 12(2): 113-7.
  4. Strom O, Borgstrom F, Kanis JA, Compston J, Cooper C, McCloskey EV, et al. Osteoporosis: burden, health care provision and opportunities in the EU: a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 2011; 6: 59-155.
  5. Jansen JP, Bergman GJ, Huels J, Olson M. The efficacy of bisphosphonates in the prevention of vertebral, hip, and nonvertebral-nonhip fractures in osteoporosis: A network meta-analysis. Semin Arthritis Rheum 2011; 40(4): 275-84.
  6. Migliore A, Broccoli S, Massafra U, Cassol M, Frediani B. Ranking antireabsorptive agents to prevent vertebral fractures in postmenopausal osteoporosis by mixed treatment comparison meta-analysis. Eur Rev Med Pharmacol Sci 2013; 17(5): 658-67.
  7. Eriksen EF. Treatment of osteopenia. Rev Endocr Metab Disord 2012; 13(3): 209-23.
  8. Saag KG, Petersen J, Brandi ML, Karaplis AC, Lorentzon M, Thomas T, et al. Romosozumab or alendronate for fracture prevention in women with osteoporosis. N Engl J Med 2017; 377(15): 1417-27.
  9. Strom O, Borgstrom F, Sen SS, Boonen S, Haentjens P, Johnell O, et al. Cost-effectiveness of alendronate in the treatment of postmenopausal women in 9 European countries--an economic evaluation based on the fracture intervention trial. Osteoporos Int 2007; 18(8): 1047-61.
  10. Schousboe JT, Nyman JA, Kane RL, Ensrud KE. Cost-effectiveness of alendronate therapy for osteopenic postmenopausal women. Ann Intern Med 2005; 142(9): 734-41.
  11. Suzuki Y, Nawata H, Soen S, Fujiwara S, Nakayama H, Tanaka I, et al. Guidelines on the management and treatment of glucocorticoid-induced osteoporosis of the Japanese Society for Bone and Mineral Research: 2014 update. J Bone Miner Metab 2014; 32(4): 337-50.
  12. Kanis JA, Cooper C, Rizzoli R, Reginster JY. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 2019; 30(1): 3-44.
  13. Erratum: Experience with alendronate treatment for four years among Japanese men with osteoporosis or osteopenia and clinical risk factors for fractures [Expression of concern]. Ther Clin Risk Manag 2018; 14: 2137.
  14. Moriwaki K, Komaba H, Noto S, Yanagisawa S, Takiguchi T, Inoue H, et al. Cost-effectiveness of alendronate for the treatment of osteopenic postmenopausal women in Japan. J Bone Miner Res 2013; 28(2): 395-403.
  15. Li M, Zhang ZL, Liao EY, Chen DC, Liu J, Tao TZ, et al. Effect of low-dose alendronate treatment on bone mineral density and bone turnover markers in Chinese postmenopausal women with osteopenia and osteoporosis. Menopause 2013; 20(1): 72-8.
  16. Schnitzer T, Bone HG, Crepaldi G, Adami S, McClung M, Kiel D, et al. Therapeutic equivalence of alendronate 70 mg once-weekly and alendronate 10 mg daily in the treatment of osteoporosis. Alendronate Once-Weekly Study Group. Aging (Milano) 2000; 12(1): 1-12.
  17. Shiraki M, Kushida K, Fukunaga M, Kishimoto H, Kaneda K, Minaguchi H, et al. A placebo-controlled, single-blind study to determine the appropriate alendronate dosage in postmenopausal Japanese patients with osteoporosis. The Alendronate Research Group. Endocr J 1998; 45(2): 191-201.
  18. Choi HJ, Im JA, Kim SH. Changes in bone markers after once-weekly low-dose alendronate in postmenopausal women with moderate bone loss. Maturitas 2008; 60(2): 170-6.
Journal of Isfahan Medical School
Volume 38, Issue 596 - Serial Number 596
September and October 2020
Pages 783-789

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History

  • Receive Date: 04 August 2020
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

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