Yearly zolendronate linked to more fractures

Once yearly intravenous zolendronate is associated with a higher rate of fractures in patients with osteoporosis compared to treatment with weekly bisphosphonates, a study by a Sydney rheumatologist finds. Writing in the Internal Medicine Journal the rheumatologists from the Royal Prince Alfred Hospital in Sydney said they had treated patients with low-trauma fractures with either bisphosphonates or intravenous ZOL since 2003; with choice of drug based on clinical criteria. In the non-randomised study 170 patients with a low trauma fracture and reduced BMD were treated with either an annual 4mg infusion of ZOL (n=70) or 70mg of oral alendronate (n=99) once weekly for at least 12 months. At baseline the ZOL group were significantly older and had a higher proportion of men. Despite similar improvements in BMD at both hip and lumbar spine, the doctors observed significantly more new major osteoporotic fractures (P<0.001) in the ZOL group (7.2%) compared to the ALM group (1%). There were no serous adverse events in either group. The authors said the increase in fractures in this group could be explained by the older cohort and the fact that there were more men. The differences may also be due to unrecognised biases at baseline, such as a frailer group with a higher risk of falls. However, to clarify this issue a randomised trial comparing both drugs was needed, the authors said. They concluded that intravenous ZOL overcomes dosing and compliance issues typically seen with oral bisphosphonates and provides a ‘safe and convenient’ alternative to weekly oral bisphosphonates. Internal Medicine Journal 2010...