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A well-designed trial has shown that alendronate reduces spinal and hip fractures by about 50% in women who have had vertebral fractures. But would alendronate benefit most postmenopausal women, who have not sustained vertebral fractures? To answer this question, this study, partially industry supported, used data from the original study of 4,432 postmenopausal women who had never sustained a vertebral fracture and were randomized to alendronate or placebo.
Bone mineral density (BMD) was increased in the alendronate group at all sites studied. Clinical fractures were reduced by 36% in women with femoral-neck BMD greater than 2.5 SD below the normal young adult mean (RR, 0.64) but not in women with higher BMD. Alendronate also decreased the r…