Does a history of non-vertebral fracture identify women without osteoporosis for treatment?
BACKGROUND
Postmenopausal women with a prior fracture have an increased risk for future fracture. Whether a history of non-vertebral fracture defines a group of women with low bone mass but without osteoporosis for whom alendronate would prevent new non-vertebral fracture is not known.


METHODS
Secondary analysis of data from the Fracture Intervention Trial (FIT). Of 2,785 postmenopausal women with a T-score at the femoral neck between -1 and -2.5 and without prevalent radiographic vertebral deformity, 880 (31.6%) reported experiencing a fracture after 45 years of age. Women were randomized to placebo or alendronate (5 mg/day years for the first 2 years and 10 mg/day thereafter) and were followed for an average of 4.2 +/- 0.5 years. Incident non-vertebral fractures were confirmed by x-rays and radiology reports.


RESULTS
In the placebo arm, a self-report of prior fracture identified women with a 1.5-fold (hazard ratio [RH] 1.46, 95% C.I. 1.04-2.04) increased risk for incident non-vertebral fracture. However, there was no evidence that the effect of alendronate differed across subgroups of women with (RH 1.26 for alendronate vs placebo, 95% C.I. 0.89-1.79) and without prior fracture (RH 1.02 for alendronate vs placebo, 95% C.I. 0.76-1.38; P = 0.37 for interaction).


CONCLUSIONS
Assessing a clinical risk factor, prior non-vertebral fracture, did not identify women with low bone mass for whom alendronate reduced future non-vertebral fracture risk.
Ryder
Kathryn M
KM
Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN 38105, USA. kryder@utmem.edu
Cummings
Steven R
SR
Palermo
Lisa
L
Satterfield
Suzanne
S
Bauer
Douglas C
DC
Feldstein
Adrianne C
AC
Schousboe
John T
JT
Schwartz
Ann V
AV
Ensrud
Kristine
K
D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000008:administration & dosage*; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D004311:Double-Blind Method; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000517:prevention & control; D010919:Placebos; D017698:Postmenopause; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors
D050071:Bone Density Conservation Agents; D010919:Placebos; D019386:Alendronate