Change in Bone Turnover and Hip, Non-Spine, and Vertebral Fracture in Alendronate-Treated Women: The Fracture Intervention Trial

• DOI: 10.1359/jbmr.040512
• Publication Date: 2006-04-27T00:44:52Z
• Authors: Douglas C Bauer; Dennis M Black; Patrick Garnero; Marc Hochberg; Susan Ott; John Orloff; Desmond E Thompson; Susan K Ewing; Pierre D Delmas
• Keywords: Aged, 80 and over; Alendronate; Hip Fractures; Patient Selection; Middle Aged; Alkaline Phosphatase; Bone and Bones; Collagen Type I; Peptide Fragments; 3. Good health; Fractures, Bone; 03 medical and health sciences; Logistic Models; 0302 clinical medicine; Double-Blind Method; Bone Density; Humans; Female; Collagen; Pelvic Bones; Peptides; Biomarkers; Aged

Abstract We used data from the Fracture Intervention Trial to assess the relationship change in bone turnover after 1 year of alendronate or placebo treatment and subsequent hip, non-spine, and spine fracture risk among 6186 postmenopausal women. In the alendronate group (n = 3105), greater reductions in one or more biochemical marker were associated with a lower risk of fracture. Introduction: There are few data on the relationship between short-term change in biochemical markers of bone turnover and non-spine fracture risk among bisphosphonate-treated women, and the clinical use of such measurements is unknown. Materials and Methods: We measured biochemical markers of bone turnover (bone-specific alkaline phosphatase [bone ALP], intact N-terminal propeptide of type I collagen, and C-terminal crosslinked telopeptide of type 1 collagen) and BMD of the spine and hip at baseline and after 1 year of alendronate or placebo. During a mean follow-up of 3.6 years, 72 hip, 786 non-spine, and 336 vertebral fractures were documented. Results and Conclusions: Each 1 SD reduction in 1-year change in bone ALP was associated with fewer spine (odds ratio = 0.74; CI: 0.63, 0.87), non-spine (relative hazard [RH] = 0.89; CI: 0.78, 1.00; p < 0.050), and hip fractures (RH = 0.61; CI: 0.46, 0.78). Alendronate-treated women with at least a 30% reduction in bone ALP had a lower risk of non-spine (RH = 0.72; CI: 0.55, 0.92) and hip fractures (RH = 0.26; CI: 0.08, 0.83) relative to those with reductions <30%. We conclude that greater reductions in bone turnover with alendronate therapy are associated with fewer hip, non-spine, and vertebral fractures, and the effect is at least as strong as that observed with 1-year change in BMD.