Cited by 752Bone health and osteoporosis researchMenopause: Health Impacts and TreatmentsBone health and treatments

Improvement in spine bone density and reduction in risk of vertebral fractures during treatment with antiresorptive drugs

Cummings, Steven R., Karpf, David B., Harris, Fran, Genant, Harry K., Ensrud, Kristine, LaCroix, Andrea Z., Black, Dennis M.·2002·The American Journal of Medicine

Abstract

Purpose To estimate how much the improvement in bone mass accounts for the reduction in risk of vertebral fracture that has been observed in randomized trials of antiresorptive treatments for osteoporosis.Methods After a systematic search, we conducted a meta-analysis of 12 trials to describe the relation between improvement in spine bone mineral density and reduction in risk of vertebral fracture in postmenopausal women. We also used logistic models to estimate the proportion of the reduction in risk of vertebral fracture observed with alendronate in the Fracture Intervention Trial that was due to improvement in bone mineral density.Results Across the 12 trials, a 1% improvement in spine bone mineral density was associated with a 0.03 decrease (95% confidence interval [CI]: 0.02 to 0.05) in the relative risk (RR) of vertebral fracture. The reductions in risk were greater than predicted from improvement in bone mineral density; for example, the model estimated that treatments predicted to reduce fracture risk by 20% (RR = 0.80), based on improvement in bone mineral density, actually reduce the risk of fracture by about 45% (RR = 0.55). In the Fracture Intervention Trial, improvement in spine bone mineral density explained 16% (95% CI: 11% to 27%) of the reduction in the risk of vertebral fracture with alendronate.Conclusion Improvement in spine bone mineral density during treatment with antiresorptive drugs accounts for a predictable but small part of the observed reduction in the risk of vertebral fracture.

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Crossref · 10.1016/s0002-9343(01)01124-x

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  • The maximum total BMD loss has been previously estimated to be 69.0% relative to astronauts' pre-flight BMD, obtained by combining data from different large studies in humans.

    “The maximum total BMD loss has been previously estimated to be 69.0% relative to the astronauts’ pre-flight BMD [18], and obtained by combining data from different large studies in humans [23,24].”

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Authors
Cummings, S. R., Karpf, D. B., Harris, F., Genant, H. K., Ensrud, K., LaCroix, A. Z., & Black, D. M.
Affiliations
  • University of California, San Francisco (US)
  • Geron (United States) (US)
  • University of Minnesota (US)
  • University of Washington (US)
Corresponding author
Cummings, Steven R.
Venue
The American Journal of Medicine
Publisher
Elsevier BV
Published
2002-03
Volume
112
Issue
4
Pages
281-289
ISSN
0002-9343 (ISSN-L)
OpenAlex
W2110828193
Cited by
752
References
35
Citations by year
2026: 7 · 2025: 10 · 2024: 17 · 2023: 12 · 2022: 12 · 2021: 16 · 2020: 25 · 2019: 10 · 2018: 11 · 2017: 18 · 2016: 25 · 2015: 19 · 2014: 24 · 2013: 29 · 2012: 43
FWCI
8.42
Type
journal article
Language
en
Open access
closed
Locations
  • The American Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Topics
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
  • Health Sciences › Medicine › Oncology › Bone health and treatments
Keywords
osteoporosis, vertebral fractures, bone mineral density, antiresorptive agents, alendronate, postmenopausal women, Fracture Intervention Trial, fracture risk reduction, bone mass
MeSH terms
Bone Resorption, Female, Fractures, Spontaneous, Humans, Regression Analysis, Risk Factors, Spine, Bone Density, Osteoporosis, Postmenopausal, Logistic Models, Spinal Fractures, Alendronate

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