Baseline characteristics (age, lumbar and hip T-Score) were similar in both groups. After 1 year of treatment, mean increases were +5.3% (P<0.001) for cortical thickness, +2.0% (P=0.002) for bone volume (BV/TV) and +2.1% (P=0.002) for trabecular density in the strontium ranelate group, whereas there was no significant change in the alendronate group, with thus a significant between-group difference in favour of strontium ranelate (P=0.045, P=0.048 and P=0.035, for cortical thickness, BV/TV and trabecular density, respectively). The increase in C.Th with strontium ranelate was +2.9%  at 3 months versus baseline (P<0.001) and was greater than in the alendronate group (P=0.012).

In conclusion, strontium ranelate had significantly higher effects than alendronate on both cortical and trabecular microstructure, in women with postmenopausal osteoporosis after one year of treatment. This effect is significant within 3 months of treatment.

1. Rizzoli R, Laroche M, Krieg MA, et al. Rheumatol Int. 2010;30(10):1341-1348.

1. Chen P et al. J Bone Miner Res. 2009; 24: 495–502.

All patients underwent the assigned intervention (68 vertebroplasties and 63 simulated procedures). The baseline characteristics were similar in the two groups. At 1 month, there was no significant difference between the vertebroplasty group and the control group in either the RDQ score or the pain rating. Both groups had immediate improvement in disability and pain scores after the intervention. Although the two groups did not differ significantly on any secondary outcome measure at 1 month, there was a trend toward a higher rate of clinically meaningful improvement in pain (a 30% decrease from baseline) in the vertebroplasty group (64% vs. 48%, P=0.06). At 3 months, there was a higher crossover rate in the control group than in the vertebroplasty group (43% vs 12%, P<0.001). There was one serious adverse event in each group.

The second study [2] was also a multicenter, randomized, double-blind, placebo-controlled trial in which 78 participants with one or two painful osteoporotic vertebral fractures that were of less than 12 months’ duration and unhealed, as confirmed by magnetic resonance imaging, were randomly assigned to undergo vertebroplasty or a sham procedure. Similar improvements were seen in both groups with respect to pain at night and at rest, physical functioning, quality of life, and perceived improvement.

In conclusion, improvements in pain and pain-related disability associated with osteoporotic compression fractures in patients treated with vertebroplasty were similar to the improvements in a control group. These studies found no beneficial effect of vertebroplasty as compared with a sham procedure in patients with painful osteoporotic vertebral fractures, up to 6 months after treatment.

1. Kallmes DF et al. N Engl J Med. 2009; 361:569-579.
2. Buchbinder R et al. N Engl J Med. 2009; 361:557-568.

Self-reported fractures were more prevalent in the current and early smokers than in the never smokers (P<.05), with a fracture prevalence odds ratio for early smokers of 1.96 after adjustment for age, weight, educational level, and alcohol use and exclusion of childhood fractures. Current smoking was associated with a significantly larger endosteal circumference and a decreased cortical thickness at the tibia. In particular, early smokers (<16 years) had a high fracture risk and lower areal BMD, together with a lower cortical bone area at the tibia and lower trabecular and cortical bone density at the radius. An interaction between free estradiol and current smoking was observed in statistical models predicting cortical area and thickness.

In conclusion, smoking at a young age is associated with unfavorable bone geometry and density and is associated with increased fracture prevalence, providing arguments for a disturbed acquisition of peak bone mass during puberty by smoking, possibly owing to an interaction with sex steroid action.

1. Taes Y et al. J Bone Miner Res. 2010;25:379-387.

Eight eligible studies of four agents (risedronate, strontium ranelate, zoledronic acid, and denosumab) were included in the primary analysis. During two alendronate studies, the treatment dose changed, and those studies were only included in secondary analyses. In the primary analysis, treatment was associated with an 11% reduction in mortality (relative risk, 0.89; P < 0.036). In the secondary analysis, the results were similar (relative risk, 0.90; P < 0.044). Mortality reduction was not related to age or incidence of hip or nonvertebral fracture, but was greatest in trials conducted in populations with higher mortality rates.

In conclusion, treatments for osteoporosis with established vertebral and nonvertebral fracture efficacy reduce mortality in older, frailer individuals with osteoporosis who are at high risk of fracture.

1. Bolland MJ et al. J Clin Endocrinol Metab. 2010;95:1174-1181.

Use of hormone replacement therapy (HRT), age, body mass index (BMI), smoking status, recorded alcohol use, parental history of osteoporosis, rheumatoid arthritis, cardiovascular disease, type 2 diabetes, asthma, tricyclic antidepressants, corticosteroids, history of falls, menopausal symptoms, chronic liver disease, gastrointestinal malabsorption, and other endocrine disorders were significantly and independently associated with risk of osteoporotic fracture in women. Some variables were significantly associated with risk of osteoporotic fracture but not with risk of hip fracture. The predictors for men for osteoporotic and hip fracture were age, BMI, smoking status, recorded alcohol use, rheumatoid arthritis, cardiovascular disease, type 2 diabetes, asthma, tricyclic antidepressants, corticosteroids, history of falls, and liver disease. The hip fracture algorithm had the best performance among men and women. It explained 63.94% of the variation in women and 63.19% of the variation in men. The ROC statistics for hip fracture were also high: 0.89 in women and 0.86 for men versus 0.79 and 0.69, respectively, for the osteoporotic fracture outcome. The algorithms were well calibrated with predicted risks closely matching observed risks. The QFractureScore for hip fracture also had good performance for discrimination and calibration compared with the FRAX (fracture risk assessment) algorithm.

These new algorithms can predict risk of fracture in primary care populations in the UK without laboratory measurements and are therefore suitable for use in both clinical settings and for self assessment (www.qfracture.org). QFractureScores could be used to identify patients at high risk of fracture who might benefit from interventions to reduce their risk.

1. Hippisley-Cox J et al. BMJ. 2009;339:b4229 doi:10.1136/bmj.b4229.

The mean serum 25(OH)D level was 61.2 ± 22.4 nM. The prevalence of 25(OH)D <25, 25–50, 50–75, and >75 nM was 5.9%, 29.4%, 43.5%, and 21.2%, respectively, in winter and 3.0%, 22.2%, 47.2%, and 27.5% in summer. Worldwide, a negative correlation between 25(OH)D and latitude was observed. With increasing 25(OH)D categories of <25, 25–50, 50–75, and >75 nM, mean PTH, OC, and CTX were decreasing (P< 0.001), whereas BMD of all sites was increasing (P< 0.001). A threshold in the positive relationship between 25(OH)D and different BMD parameters was visible at a 25(OH)D level of 50 nM.

This study showed a high prevalence of low 25(OH)D in postmenopausal women with osteoporosis worldwide. Along with latitude, affluence seems to be an important factor for serum 25(OH)D level, especially in Europe, where it is strongly correlated with latitude.

1. Kuchuk NO et al. J Bone Miner Res. 2009;24:693-701.

Although the Bcl-x knockout mice grew normally with no apparent morphological abnormalities, they developed substantial osteopenia at 1 year of age, which was caused by increased bone resorption. Bcl-x deficiency increased the bone-resorbing activity of osteoclasts despite their high susceptibility to apoptosis, whereas Bcl-xL overexpression produced the opposite effect. In addition, Bcl-x knockout osteoclasts displayed increased levels of vitronectin and fibronectin expression.

These results suggest that Bcl-xL attenuates osteoclastic bone-resorbing activity through the decreased production of extracellular matrix proteins, such as vitronectin and fibronectin, and thus provides evidence for a novel cellular function of Bcl-xL.

1. Iwasawa M et al. J Clin Invest. 2009;119:3149-3159.

A total of 6451 men (mean age, 63.8 y) and 6936 women (mean age, 63.1 y) were included in the analysis. Mean follow-up time was 3 y. Of these, 574 (8.9%) men and 313 (4.5%) women reported a first fracture (any site) between the ages of 8 and 18 y. A recalled history of any childhood fracture or forearm fracture was not associated with an increased risk of future limb fracture or prevalent vertebral deformity in either men or women. Among the 4807 subjects who had DXA measurements, there was no difference in bone mass among those subjects who had reported a childhood fracture and those who did not.

These data suggest that self-reported previous childhood fracture is not associated with an increased risk of future fracture in men or women.

1. Pye SR et al. J Bone Miner Res. 2009;24:1314–1318.

During follow-up, 1,676 (0.3%) were admitted to hospital with a first incident hip fracture. Among women aged 50-54 y the relative risk (RR) of hip fracture was significantly higher in postmenopausal than premenopausal women (adjusted RR 2.22); there were too few premenopausal women aged 55 y and over for valid comparisons. Among postmenopausal women, hip fracture incidence increased steeply with age (p<0.001), with rates being about seven times higher at age 70-74 y than at 50-54 y (incidence rates of 0.82 versus 0.11 per 100 women over 5 y). Among postmenopausal women of a given age there was no significant difference in hip fracture incidence between women whose menopause was due to bilateral oophorectomy compared with a natural menopause (adjusted RR 1.20), and age at menopause had little, if any, effect on hip fracture incidence.

In conclusion, at around the time of the menopause, hip fracture incidence is about twice as high in postmenopausal as in premenopausal women, but this effect is short-lived. Among postmenopausal women, age is by far the main determinant of hip fracture incidence and, for women of a given age, their age at menopause has, at most, a weak additional effect.

1. Banks E, et al. PLoS Med. 2009;6:e1000181.doi:10.1371/journal.pmed.1000181.