LAUSR

Nature reviews | E n d o c r i n o l o g y Original article Reid, I. R. et al. Fracture prevention with zoledronate in older women with osteopenia. N. Engl. J. Med. https://doi.org/ 10.1056/NEJMoa1808082 (2018) women treated with zoledronate had a lower risk of nonvertebral fragility ... fractures Currently, the majority of fractures reported in postmenopausal women are in individuals who have osteopenia, rather than in women who have osteoporosis. Patients with osteoporosis are treated with bisphosphonates to prevent fractures; however, their efficacy in preventing fractures in patients with osteopenia is unknown. Now, new research by ian reid and colleagues shows that treating women with osteopenia with zoledronate, a bisphosphonate used to treat osteoporosis, reduces the risk of fracture. reid and his team conducted a randomized, double-blind, placebo-controlled trial to test the efficacy of zoledronate in preventing fractures in postmenopausal women who have osteopenia or are on the cusp of developing osteoporosis. the authors recruited 2,000 women (≥65 years) with a t score of −1.0 to −2.5 at either the total hip or the femoral neck and were randomly assigned to either receive the treatment or placebo. the treatment group received four intravenous injections of zoledronate at 18-month intervals, while the placebo group received saline. all participants were followed for 6 years and the primary end point was time taken for the first fragility fracture (vertebral or nonvertebral) to occur. in the study, 190 women from the placebo group and 122 women from the treatment group developed fragility fractures (Hr with zoledronate = 0.63; 95% Ci 0.50–0.79; P < 0.001). the authors found that women treated with zoledronate had a lower risk of nonvertebral fragility, symptomatic and vertebral fractures and loss of height compared with the placebo group. “these findings suggest that prescribing zoledronate to a wider group of women ≥65 years of age than we currently do would be worthwhile with regard to preventing fractures,” concludes reid. “the evidence that zoledronate is effective when given at 18-month intervals, together with other evidence that its duration of action extends to many years, suggests that longer interdose intervals should be assessed.” Ivone Leong B O n e