Ten years' experience with alendronate for osteoporosis in postmenopausal women.
BACKGROUND
Antiresorptive agents are widely used to treat osteoporosis. We report the results of a multinational randomized, double-blind study, in which postmenopausal women with osteoporosis were treated with alendronate for up to 10 years.


METHODS
The initial three-year phase of the study compared three daily doses of alendronate with placebo. Women in the original placebo group received alendronate in years 4 and 5 and then were discharged. Women in the original active-treatment groups continued to receive alendronate during the initial extension (years 4 and 5). In two further extensions (years 6 and 7, and 8 through 10), women who had received 5 mg or 10 mg of alendronate daily continued on the same treatment. Women in the discontinuation group received 20 mg of alendronate daily for two years and 5 mg daily in years 3, 4, and 5, followed by five years of placebo. Randomized group assignments and blinding were maintained throughout the 10 years. We report results for the 247 women who participated in all four phases of the study.


RESULTS
Treatment with 10 mg of alendronate daily for 10 years produced mean increases in bone mineral density of 13.7 percent at the lumbar spine (95 percent confidence interval, 12.0 to 15.5 percent), 10.3 percent at the trochanter (95 percent confidence interval, 8.1 to 12.4 percent), 5.4 percent at the femoral neck (95 percent confidence interval, 3.5 to 7.4 percent), and 6.7 percent at the total proximal femur (95 percent confidence interval, 4.4 to 9.1 percent) as compared with base-line values; smaller gains occurred in the group given 5 mg daily. The discontinuation of alendronate resulted in a gradual loss of effect, as measured by bone density and biochemical markers of bone remodeling. Safety data, including fractures and stature, did not suggest that prolonged treatment resulted in any loss of benefit.


CONCLUSIONS
The therapeutic effects of alendronate were sustained, and the drug was well tolerated over a 10-year period. The discontinuation of alendronate resulted in the gradual loss of its effects.
Bone
Henry G
HG
Michigan Bone and Mineral Clinic, Detroit 48236, USA.
Hosking
David
D
Devogelaer
Jean-Pierre
JP
Tucci
Joseph R
JR
Emkey
Ronald D
RD
Tonino
Richard P
RP
Rodriguez-Portales
Jose Adolfo
JA
Downs
Robert W
RW
Gupta
Jayanti
J
Santora
Arthur C
AC
Liberman
Uri A
UA
D000368:Aged; D019386:Alendronate / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D001827:Body Height / Q000187:drug effects; D015519:Bone Density / Q000187:drug effects*; D016723:Bone Remodeling / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy*; D011859:Radiography; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000517:prevention & control; D013997:Time Factors
D019386:Alendronate