To Prevent Fractures, Treating Only Women with Osteoporosis May Not Be Enough

The conventional bone mineral density threshold for initiating treatment to prevent fragility fractures is a T score less than −2.5 (the WHO criteria for osteoporosis). However, most fractures among postmenopausal women occur in those with low bone mass (osteopenia). In a trial in New Zealand, investigators randomized 2000 women aged ≥65 (mean age, 71; 94% European ethnicity) with osteopenia of the hip to receive 4 intravenous infusions of 5-mg zoledronate or placebo at 18-month intervals.

At baseline, mean total hip T scores were −1.27 (zoledronate group) and −1.24 (placebo group). At 6-year follow-up, fragility fractures had occurred in 122 and 190 participants in the zoledronate acid and placebo groups, respectively (hazard ratio, 0.63; 9…