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Was alendronate really ineffective?




In his editorial, Dr. Barbieri presented the case of a woman who initiated denosumab after alendronate failed to increase her bone density. He later characterized that alendronate therapy as "unsuccessful." I wonder if Dr. Barbieri could clarify what he means by that assessment. Given that the woman's T-score at her hip remained stable despite concomitant use of an aromatase inhibitor, I would not necessarily conclude that it was unsuccessful.

Ronald Orleans, MD

Bethesda, Md

Dr. Barbieri responds:

Assessing, the effect of alendronate is not always simple I appreciate Dr. Orleans's comment and the time he took from his busy practice to raise a clinically important issue. I agree with him: Determining whether alendronate therapy has been successful in the treatment of osteoporosis is not straightforward. In most patients, if bone density increases or remains stable, alendronate therapy is considered successful. If bone density decreases, as it did in this patient, the question arises: How much of a decrease in bone density is clinically or statistically significant? One approximation that can be made is if bone density, as measured in grams per square centimeter, decreases by 4.16%, there is a 95% likelihood that it represents a real decrease--one that would be reproduced if the test were performed over and over again. In addition to a decrease in bone mineral density, this patient also had a low-impact fracture, strongly suggesting that the alendronate was not highly effective in her case.



(1.) Bonnick SL, Johnston CC, Kleerekoper M, et al. Importance of precision in bone-density measurements. J Clin Densitom. 2001;4(2):105-110.

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Title Annotation:Comment & Controversy
Author:Orleans, Ronald
Publication:OBG Management
Geographic Code:1USA
Date:Mar 1, 2011
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