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Nitroglycerin may improve postmenopausal bone strength
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Two years of treatment with nitroglycerin ointment appears to lead to modest increases in areal bone mineral density at the lumbar spine, total hip and femoral neck, as well as decreases in bone resorption, in postmenopausal women.
“Nitroglycerin stimulates bone formation and inhibits bone resorption, is inexpensive and is widely available,” Sophie A. Jamal, MD, PhD, of the Women’s College Research Institute and University of Toronto, and colleagues wrote in a new study. However, “its effect on bone density, bone structure and bone strength are unknown.”
To fill these gaps in knowledge, Jamal and colleagues conducted a 24-month, single-center, double blind, placebo-controlled trial from November 2005 to March 2010. The researchers selected 243 women aged 50 years and older with BMD T-scores between 0 and –2 at the lumbar spine and higher than –2 at the total hip. The participants were then randomly assigned to receive treatment with nitroglycerin ointment or placebo, which was applied once daily at bedtime.
Changes in BMD
At the study’s conclusion, the researchers noted a significant 6.7% increase in areal BMD at the lumbar spine among women in the nitroglycerin group (95% CI, 5.2-8.2). Likewise, results linked nitroglycerin with a 6.2% increase in areal BMD at the total hip (95% CI, 5.6-7) and a 7% increase at the femoral neck (95% CI, 5.5-8.5).
Volumetric trabecular BMD also increased by 11.9% at the radius and 8.5% at the tibia. Similar increases of 7.4% at the radius and 2.9% at the tibia were noted in periosteal circumference, and polar section modulus rose by 10.7% at the radius and 9.8% at the tibia. Increases of 7.3% at the radius and 14.5% at the tibia were also reported for polar moment of inertia. Additionally, nitroglycerin use was associated with a 34.8% increase in bone-specific alkaline phosphatase, as well as a 54% decrease in urine N-telopeptide.
Headache was the most commonly reported adverse event and was considerably more prominent in the nitroglycerin group (35%) vs. the placebo group (5.4%) during the first month of use. However, headaches declined substantially among nitroglycerin users after 1 year, the researchers reported.
Implications
The researchers said their findings put nitroglycerin’s efficacy on par with many existing treatments, such as teriparatide. They also said nitrates “have a potential advantage of easy administration as an ointment, patch, or pill and wide availability of generic preparations.”
In an accompanying editorial, Sundeep Khosla, MD, of the College of Medicine, Mayo Clinic in Rochester, Minn., discussed the contrasting results of this study with those conducted previously.
“Despite the differences in the results of the study by Jamal et al compared with the largely negative study by Wimalawansa et al, the findings reported by Jamal et al should set the stage for an adequately powered, larger study using nitroglycerin ointment with fracture as an outcome,” Khosla wrote. “If such a study demonstrates efficacy for reducing fractures, clinicians would have a novel and inexpensive therapy for osteoporosis.”
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Disclosures: Several researchers reported being board members, paid consultants and lecturers for various pharmaceutical companies and organizations. Dr. Khosla reported serving on a scientific advisory board for Amgen.
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