title: Comparison of the effects of three oral bisphosphonate therapies on the peripheral skeleton in postmenopausal osteoporosis: the TRIO study.
abstract: We compared the effects of oral alendronate, ibandronate and risedronate on the central and peripheral skeleton over 2 years. We report differences in effect on the central skeleton but not on the peripheral skeleton. Greater effects were observed for ibandronate (and alendronate) than risedronate at the spine but not the hip.
  
  
  BACKGROUND
  Generally, comparative clinical trials of bisphosphonates have examined changes in bone within central skeletal regions. We have examined the effects of bisphosphonate treatment on the peripheral skeleton.
  
  
  METHODS
  We conducted a 2-year, open-label, parallel randomised control trial of three orally administered bisphosphonates, at their licensed dose, to examine and compare their effects on the peripheral skeleton using multiple modes of measurement. We studied 172 postmenopausal women (53-84 years) who had either a bone mineral density (BMD) T-score of  ≤ -2.5 at the spine and/or total hip or  < -1.0 at either site plus a previous low trauma fracture. Participants were randomised to receive either (i) ibandronate 150 mg/month, (ii) alendronate 70 mg/week or (iii) risedronate 35 mg/week, plus calcium (1,200 mg/day) and vitamin D (800 IU/day), for 2 years. Premenopausal women (33-40 years, n = 226) were studied to monitor device stability.
  
  
  RESULTS
  We measured central BMD of the lumbar spine, total hip, total body and forearm using dual-energy X-ray absorptiometry. We measured calcaneus BMD (using dual-energy X-ray absorptiometry plus laser), radius and tibia BMD (using peripheral quantitative computed tomography), finger BMD (using radiographic absorptiometry), and phalangeal and calcaneal ultrasound variables (using quantitative ultrasound). Mixed effects regression models were used to evaluate effects of time and treatment allocation on BMD change. By 2 years, there were significant increases (p < 0.05) in central BMD sites (lumbar spine, total hip). In the peripheral skeleton, only significant changes in calcaneus BMD, 33 % total radius BMD and quantitative ultrasound (QUS)-2 broadband ultrasound attenuation (BUA) were evident for women receiving oral bisphosphonates.
  
  
  CONCLUSIONS
  The increases in lumbar spine and total body BMD were greater with ibandronate and alendronate than with risedronate. Treatment effects on peripheral measurements did not differ between the three bisphosphonates.
authors: Academic Unit of Bone Metabolism, The Mellanby Centre for Bone Research, The University of Sheffield, South Yorkshire, UK, m.a.paggiosi@sheffield.ac.uk.
authors: M A
authors: MA
authors: Paggiosi
authors: N
authors: N
authors: Peel
authors: E
authors: E
authors: McCloskey
authors: J S
authors: JS
authors: Walsh
authors: R
authors: R
authors: Eastell
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D004164:Diphosphonates / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006621:Hip Joint / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D000077557:Ibandronic Acid; D035002:Lower Extremity / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000187:drug effects / Q000503:physiopathology; D055118:Medication Adherence; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy* / Q000503:physiopathology; D000068296:Risedronic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D034941:Upper Extremity / Q000503:physiopathology
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D000068296:Risedronic Acid; D000077557:Ibandronic Acid; D019386:Alendronate