title: Characteristics associated with bone mineral density responses to alendronate in men.
abstract: Some patients experience reduced bone mineral density (BMD) despite bisphosphonate therapy. We performed a retrospective chart review study to detect factors associated with decreased BMD in men prescribed alendronate. Two investigators reviewed eligible medical records and used a standardized form to record potential characteristics predicting men's response to alendronate. We analyzed patient characteristics associated with annualized change in hip and spine BMD (D-BMD). Among 115 eligible men, 19 (17 %) experienced significantly decreased BMD at the hip or spine, defined as a change exceeding precision error. Eleven men (10 %) fractured during therapy. Spine D-BMD was positively associated with adherence to alendronate (R = 0.23, p = 0.02) and inversely associated with baseline body weight (R = -0.21, p = 0.03). Hip D-BMD was positively associated with annualized weight change (R = 0.19, p = 0.0498) and negatively associated with patient age and number of concomitant medications (R = -0.21, p = 0.03; R = -0.20, p = 0.03, respectively). In stepwise linear models, spine D-BMD was associated positively with alendronate adherence and multivitamin use and negatively with baseline body weight. Hip D-BMD was negatively associated with age. Fracture during treatment was associated with fracture prior to therapy (p = 0.03). In this small study of men prescribed alendronate, BMD response showed a positive association with adherence to therapy, weight gain, and use of a multivitamin. By contrast, older age, higher baseline body weight, and higher number of medications were each associated with a decrease in BMD. Larger studies are needed to confirm and extend these findings.
authors.affiliation: Mercy Arthritis and Osteoporosis Center, Urbandale, IA, 50322, USA.
authors.forename: Erik D
authors.initials: ED
authors.lastname: Swenson
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hansen
authors.forename: Andrea N
authors.initials: AN
authors.lastname: Jones
authors.forename: Zhanhai
authors.initials: Z
authors.lastname: Li
authors.forename: Brooke
authors.initials: B
authors.lastname: Baltz-Ward
authors.forename: Arthur A
authors.initials: AA
authors.lastname: Schuna
authors.forename: Mary E
authors.initials: ME
authors.lastname: Elliott
mesh_terms: D015502:Absorptiometry, Photon; D000367:Age Factors; D000368:Aged; D019386:Alendronate / Q000627:therapeutic use*; D001835:Body Weight; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D006615:Hip / Q000000981:diagnostic imaging; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D010024:Osteoporosis / Q000517:prevention & control*; D012189:Retrospective Studies
chemical_list: D050071:Bone Density Conservation Agents; D019386:Alendronate