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Alendronate, zoledronic acid equally effective in osteogenesis imperfecta
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Compared with healthy adults, patients with osteogenesis imperfecta have significantly lower bone mass and higher bone resorption biomarkers, published data show.
Bone mineral density is increased and bone turnover biomarkers was inhibited in adults with osteogenesis imperfecta with both oral alendronate and IV zoledronic acid, according to the researchers.
Mei Li, MD, of the department of endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences in Beijing, and colleagues evaluated 60 adults (mean age, 31.2 years) with osteogenesis imperfecta recruited between August 2010 and September 2012 to determine the effects of 70 mg alendronate (Fosamax, Merck) weekly and IV 5 mg zoledronic acid (Aclasta, Novartis Pharmaceuticals) annually on BMD, bone turnover markers and fracture incidence. Participants were randomly assigned to alendronate (n = 40) or zoledronic acid (n = 20). Follow-up was conducted at 6-month intervals for 2 years.
BMD at the lumbar spine and proximal hip were increased in both groups after 24 months (P < .05 for all). No significant differences were found between the groups for percent changes in lumbar spine, femoral neck and total hip.
During treatment, serum levels of bone turnover biomarkers, including alkaline phosphatase (P = .12 between group) and cross-linked C-telopeptide of type 1 collagen (P = .48 between groups), decreased rapidly. Seventeen percent of participants had new fractures during the first year of treatment, for an annual fracture incidence of 0.29 per person-years for the alendronate group and 0.2 per person-years for the zoledronic acid group. During the second year, the annual fracture incidence was 0.05 per person-year in the alendronate group and 0.15 per person-year in the zoledronic acid groups (P = .266 between groups).
“Adult patients with [osteogenesis imperfecta] have relatively high bone turnover biomarkers, decreased bone mass and increased fracture risk than healthy population, which indicates they still need to receive treatment,” the researchers wrote. “Oral alendronate and [IV] zoledronic acid are similarly beneficial to increase BMD and inhibit bone turnover. The fracture rate after treatment is lower to prior rates, but it is not powered to demonstrate a definitive efficacy on bone fractures. Future randomized, placebo-controlled, prospective studies in a large sample of adults with [osteogenesis imperfecta] are still needed to demonstrate [bisphosphonates] anti-fracture efficacy.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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