Study Offers Hope For Osteoporosis Prevention

A widely available drug could stave off the effects of osteoporosis when given preventively, a new study finds.

A drug that is widely used to slow down bone-loss in older women and prevent related fractures could in future be used only once or twice in younger women in their 50s and 60s to prevent fractures.

About half of women experience a fracture after they reach menopause. Vertebral fractures occur in the spine when bones become fragile with osteoporosis.

Currently, fractures can be prevented by infusions of zoledronate every 12 to 18 months.

The new study tested whether the less frequent infusions, every five to ten years, early on after menopause would prevent fractures over a ten-year period.

“At the moment, our strategy to prevent fractures is to wait until people are at high risk of fracture and then offer treatment with drugs like zoledronate,” says lead author Associate Professor Mark Bolland from Waipapa Taumata Rau, University of Auckland.

High risk might be due to any combination of older age, low bone density, recurrent falls, or previous fractures.

“But there has always been an alternate view – why not start treatment early, prevent any age-related bone loss, and then maybe when you are older, because your bone density is much higher than it would otherwise have been, you’ll have a much lower risk of fracture,” Bolland says.

“We’ve never really been able to test that hypothesis because treatments haven’t been suitable – what 50-something person wants to take a medication each day for potentially 30 to 50 years to try and prevent something that may never happen?”

The new study tested whether the less frequent infusions, every five to ten years, early on after menopause would prevent fractures over a ten-year period.

The novel study, just published in the world-leading New England Journal of Medicine, found zoledronate, a bisphosphonate, is effective at preventing fractures, in younger postmenopausal women, aged 50 to 60 years, even at a single dose given at five or ten-year frequencies. Read the article.

The trial followed more than 1,000 postmenopausal women aged 50 to 60 years for 10 years, with one-third receiving one infusion of zoledronate, one-third receiving two infusions five years apart and the remainder receiving placebo. Neither patients nor clinicians knew whether the infusions were zoledronate or placebo.

“This study showed us that either one or two zoledronate infusions reduced the risk of vertebral fractures by 41 to 44 percent and all fractures by 23 to 30 percent,” says Bolland.

It found that treating 21 women with two infusions of zoledronate every five years or 22 women with a single infusion of zoledronate would prevent one woman having a vertebral fracture.

There were no important safety concerns from using zoledronate.

“No-one has given zoledronate so infrequently before, and I suspect many people will find the results astonishing, because there are very few examples of a medicine having effects that last so long.

“When the treatment was first introduced, people were sceptical that a treatment could last for a year. So now we’ve extended that to five to ten years.

“The results open, for the first time, the idea that perhaps a 50-something woman could have several infusions in her remaining life, keep her bone density close to the level it was when she started treatment, and dramatically reduce her risk of fracture as she ages.

“The results show that for the first ten years this approach is effective (and more effective than we could have hoped for) and leaves us optimistic that the benefits of five or ten-yearly zoledronate will continue after that. We are doing an extension study to test this.”

Zoledronate is widely available, costs about $20 for the medicine, and ranges from free to around $100 to $150 for the infusion, so this option should not be expensive, and women could start talking to their doctors about it now.

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