Ten years' experience with alendronate for osteoporosis in postmenopausal women

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Bone, Henry G.¹; Hosking, David²; Devogelaer, Jean-Pierre³; Tucci, Joseph R.⁴; Emkey, Ronald D.⁵; Tonino, Richard P.⁶; Rodriguez-Portales, Jose Adolfo⁷; Downs, Robert W.⁸; Gupta, Jayanti⁹; Santora, Arthur C.⁹; Liberman, Uri A.¹⁰

Ten years' experience with alendronate for osteoporosis in postmenopausal women

NEJM. March 18, 2004;350(12):1189-1199

©2004 Massachusetts Medical Society

Affiliations

¹Michigan Bone and Mineral Clinic, Detroit

²Medical Research Center, Nottingham City Hospital, Nottingham, United Kingdom

³Saint-Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium

⁴Department of Medicine, Roger Williams General Hospital, Providence, R.I

⁵Radiant Research–Reading, Wyomissing, Pa.

⁶Good Health Associates in Adult Medicine, South Burlington, Vt.

⁷Departamento de Endocrinologia, Escuela de Medicina, Universidad Catolica de Chile, Santiago, Chile

⁸Virginia Commonwealth University, Richmond

⁹Merck Research Laboratories, Rahway, N.J.

¹⁰Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Petah-Tikva, Israel
Abstract

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.
Links

DOI: 10.1056/NEJMoa030897

PubMed: 15028823

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