T Score at Bisphosphonate's End May Predict Risk of Fractures

Major Finding: Patients withdrawn from bisphosphonate treatment after 5 years on the drug with a total hip T score of more than −1.5 had a 9% risk for any clinical fracture during the following 5 years. Patients with a T score of −1.5 to −2.1 at the time bisphosphonate treatment stopped had a 23% fracture rate during the next 5 years. Patients with a total hip T score of less than −2.1 had a 33% fracture rate during the 5 years after bisphosphonate withdrawal.

Data Source: Review of 437 postmenopausal women enrolled in the FLEX study who were randomized to placebo following 5 years of continuous alendronate treatment.

Disclosures: Dr. Bauer said he received research funding from Amgen, Merck, and Novartis. The FLEX study was sponsored by Merck.

TORONTO — The stronger a patient's bones are when bisphosphonate treatment is stopped, the less likely the bones are to fracture later, based on an analysis of 437 patients.

In contrast, changes in bone mineral density following the end of bisphosphonate therapy had no significant link with subsequent fracture risk, said Dr. Douglas C. Bauer of the University of California, San Francisco

The finding calls into doubt the common practice of running annual dual-energy x-ray absorptiometry examinations on patients who have withdrawn from bisphosphonate treatment.

Routine BMD measurement “1–2 years after stopping prolonged alendronate therapy may not be useful for predicting the patient's fracture risk,” Dr. Bauer said. The BMD at the time of alendronate discontinuation “was highly predictive of who was going to fracture.”

Patients who stopped alendronate therapy with a total hip BMD T score of −1.4 or greater had a 9% rate of clinical fracture during 5 years of follow-up.

Patients with a T score of −2.1 to −1.5 when they stopped bisphosphonate treatment had a 23% fracture rate during 5 years of follow-up, and those who stopped with a T score lower than −2.1 had a 33% fracture rate over the next 5 years. The between-group differences were statistically significant.

Dr. Bauer and his associates used data collected in the FLEX (Fracture Intervention Trial Long-Term Extension) study, which randomized 1,099 postmenopausal women who had completed 5 years of treatment with alendronate to either continue on alendronate for another 5 years or switch to placebo (JAMA 2006;296:2927–38). They focused on the 437 patients who switched to placebo.

Even among patients who had relatively substantial bone loss during 1 year of follow-up, the amount of lost BMD did not significantly correlate with their follow-up fracture rate.

The researchers saw no significant link to fracture rate among the 21% of patients who lost at least 3% of their BMD during the first year of follow-up, or among the 8% of patients who lost at least 5% of their BMD during 1 year of follow-up.

Major Finding: Patients withdrawn from bisphosphonate treatment after 5 years on the drug with a total hip T score of more than −1.5 had a 9% risk for any clinical fracture during the following 5 years. Patients with a T score of −1.5 to −2.1 at the time bisphosphonate treatment stopped had a 23% fracture rate during the next 5 years. Patients with a total hip T score of less than −2.1 had a 33% fracture rate during the 5 years after bisphosphonate withdrawal.

Data Source: Review of 437 postmenopausal women enrolled in the FLEX study who were randomized to placebo following 5 years of continuous alendronate treatment.

Disclosures: Dr. Bauer said he received research funding from Amgen, Merck, and Novartis. The FLEX study was sponsored by Merck.

TORONTO — The stronger a patient's bones are when bisphosphonate treatment is stopped, the less likely the bones are to fracture later, based on an analysis of 437 patients.

In contrast, changes in bone mineral density following the end of bisphosphonate therapy had no significant link with subsequent fracture risk, said Dr. Douglas C. Bauer of the University of California, San Francisco

The finding calls into doubt the common practice of running annual dual-energy x-ray absorptiometry examinations on patients who have withdrawn from bisphosphonate treatment.

Routine BMD measurement “1–2 years after stopping prolonged alendronate therapy may not be useful for predicting the patient's fracture risk,” Dr. Bauer said. The BMD at the time of alendronate discontinuation “was highly predictive of who was going to fracture.”

Patients who stopped alendronate therapy with a total hip BMD T score of −1.4 or greater had a 9% rate of clinical fracture during 5 years of follow-up.

Patients with a T score of −2.1 to −1.5 when they stopped bisphosphonate treatment had a 23% fracture rate during 5 years of follow-up, and those who stopped with a T score lower than −2.1 had a 33% fracture rate over the next 5 years. The between-group differences were statistically significant.

Dr. Bauer and his associates used data collected in the FLEX (Fracture Intervention Trial Long-Term Extension) study, which randomized 1,099 postmenopausal women who had completed 5 years of treatment with alendronate to either continue on alendronate for another 5 years or switch to placebo (JAMA 2006;296:2927–38). They focused on the 437 patients who switched to placebo.

Even among patients who had relatively substantial bone loss during 1 year of follow-up, the amount of lost BMD did not significantly correlate with their follow-up fracture rate.

The researchers saw no significant link to fracture rate among the 21% of patients who lost at least 3% of their BMD during the first year of follow-up, or among the 8% of patients who lost at least 5% of their BMD during 1 year of follow-up.

Major Finding: Patients withdrawn from bisphosphonate treatment after 5 years on the drug with a total hip T score of more than −1.5 had a 9% risk for any clinical fracture during the following 5 years. Patients with a T score of −1.5 to −2.1 at the time bisphosphonate treatment stopped had a 23% fracture rate during the next 5 years. Patients with a total hip T score of less than −2.1 had a 33% fracture rate during the 5 years after bisphosphonate withdrawal.

Data Source: Review of 437 postmenopausal women enrolled in the FLEX study who were randomized to placebo following 5 years of continuous alendronate treatment.

Disclosures: Dr. Bauer said he received research funding from Amgen, Merck, and Novartis. The FLEX study was sponsored by Merck.

TORONTO — The stronger a patient's bones are when bisphosphonate treatment is stopped, the less likely the bones are to fracture later, based on an analysis of 437 patients.

In contrast, changes in bone mineral density following the end of bisphosphonate therapy had no significant link with subsequent fracture risk, said Dr. Douglas C. Bauer of the University of California, San Francisco

The finding calls into doubt the common practice of running annual dual-energy x-ray absorptiometry examinations on patients who have withdrawn from bisphosphonate treatment.

Routine BMD measurement “1–2 years after stopping prolonged alendronate therapy may not be useful for predicting the patient's fracture risk,” Dr. Bauer said. The BMD at the time of alendronate discontinuation “was highly predictive of who was going to fracture.”

Patients who stopped alendronate therapy with a total hip BMD T score of −1.4 or greater had a 9% rate of clinical fracture during 5 years of follow-up.

Patients with a T score of −2.1 to −1.5 when they stopped bisphosphonate treatment had a 23% fracture rate during 5 years of follow-up, and those who stopped with a T score lower than −2.1 had a 33% fracture rate over the next 5 years. The between-group differences were statistically significant.

Dr. Bauer and his associates used data collected in the FLEX (Fracture Intervention Trial Long-Term Extension) study, which randomized 1,099 postmenopausal women who had completed 5 years of treatment with alendronate to either continue on alendronate for another 5 years or switch to placebo (JAMA 2006;296:2927–38). They focused on the 437 patients who switched to placebo.

Even among patients who had relatively substantial bone loss during 1 year of follow-up, the amount of lost BMD did not significantly correlate with their follow-up fracture rate.

The researchers saw no significant link to fracture rate among the 21% of patients who lost at least 3% of their BMD during the first year of follow-up, or among the 8% of patients who lost at least 5% of their BMD during 1 year of follow-up.