Slow-release sodium fluoride in the management of postmenopausal osteoporosis. A randomized controlled trial.
OBJECTIVE
To test whether intermittent treatment with slow-release sodium fluoride and continuous calcium citrate supplementation inhibits vertebral fractures without causing fluoride complications.


METHODS
A placebo-controlled, randomized trial.


METHODS
Outpatient setting of specialty clinics in Dallas and Temple, Texas.


METHODS
Slow-release sodium fluoride (25 mg twice daily) in repeated 14-month cycles (12 months on treatment followed by 2 months off treatment) compared with placebo. Both groups took calcium citrate (400 mg calcium twice daily) continuously.


METHODS
110 patients with postmenopausal osteoporosis were randomly assigned to two groups. In the slow-release sodium fluoride group, 48 of 54 patients completed more than 1 cycle of treatment (mean, 2.44 cycles/patient), whereas 51 of 56 patients in the placebo group completed at least 1 cycle (mean, 2.14 cycles/patient) in this interim analysis.


METHODS
Vertebral fracture rate and lumbar bone mineral content. Vertebral fractures were quantified from yearly radiographs. Bone mass was determined annually by densitometry.


RESULTS
In the sodium fluoride group, the mean L2 to L4 bone mineral content increased by 4% to 6% in each cycle and the mean femoral neck bone density increased by 4.1% and 2.1% during the first two cycles, but the radial bone density did not change. The placebo group showed no statistical change in bone mass at any site. Compared with the placebo group, the sodium fluoride group had a lower individual new vertebral fracture rate (0.057/patient cycle compared with 0.204/patient cycle, P = 0.017), a higher fracture-free rate (83.3% compared with 64.7%, P = 0.042), and a lower group fracture rate (0.085/patient cycle compared with 0.239/patient cycle, P = 0.006). The side-effect profile was similar for the two groups; no patient developed microfractures, hip fractures, or blood loss anemia.


CONCLUSIONS
Intermittent slow-release sodium fluoride plus continuous calcium citrate, administered for about 2.5 years, inhibits new vertebral fractures, increases the mean spinal bone mass without decreasing the radial shaft bone density, and is safe to use.
Pak
C Y
CY
University of Texas Southwestern Medical Center, Dallas.
Sakhaee
K
K
Piziak
V
V
Peterson
R D
RD
Breslau
N A
NA
Boyd
P
P
Poindexter
J R
JR
Herzog
J
J
Heard-Sakhaee
A
A
Haynes
S
S
Adams-Huet
B
B
Reisch
J S
JS
D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D002951:Citrates / Q000008:administration & dosage*; D019343:Citric Acid; D003692:Delayed-Action Preparations; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D015914:Estrogen Replacement Therapy; D005260:Female; D005459:Fluorides / Q000097:blood; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000097:blood / Q000188:drug therapy*; D012969:Sodium Fluoride / Q000008:administration & dosage* / Q000009:adverse effects; D016103:Spinal Fractures / Q000517:prevention & control
D002951:Citrates; D003692:Delayed-Action Preparations; D019343:Citric Acid; D012969:Sodium Fluoride; D005459:Fluorides