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Greenspan et al. Zoledronic acid boosts BMD in institutionalized elderly women



DOI:10.1038/bonekey.2015.102

Elderly post-menopausal women in institutions are at high fracture risk but rarely receive treatment for osteoporosis and few participate in RCTs. This trial investigated the impact of a single 5 mg dose of zoledronic acid (ZA) in 181 such women, all aged over 65.

All women received daily supplements of calcium and vitamin D; one group then received a single 5 mg dose of ZA while controls were given a placebo injection. Bone mineral density (BMD) at the hip and spine were analyzed at 12 and 24 months.

Women in the ZA group showed significantly greater increases in total hip BMD compared to controls at both time points (P=0.01 in both cases). Mean BMD percentage point differences of 3.2 and 3.9 were noted at 12 and 24 months respectively. Increases in BMD at the spine were also measured with percentage point differences 1.8 and 3.6 at the two time points (P<0.1).

Fracture rates were greater in the ZA group (20 vs 16%) but this was not significant when adjustments were made for the greater level of frailty in the treatment group.

Editor’s comment: It is interesting that a single dose of ZA in women above 65 provides a two-year inhibition of bone turnover at the spine as well as eliciting total hip BMD gain. However, it remains unproven whether this would translate into fracture protection, particularly at cortical bone sites, bearing in mind the temporary impact of therapy on femoral neck BMD.


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