Randomized controlled trials Black et al recently reported an an

Randomized controlled trials Black et al. recently reported an analysis of subtrochanteric and diaphyseal

fractures in the Fracture Intervention Trial (FIT) of alendronate and its extension [1, 2, 5, 68] and the HORIZON Pivotal Fracture Trial (PFT) of zoledronic acid 5 mg [3]. Twelve fractures in ten patients were documented in the subtrochanteric or diaphyseal region (Table 3) a combined rate of 2.3 per 10,000 patient-years [69]. However, radiographs were not available to confirm typical vs atypical radiographic Peptide 17 features. There was no significant increase over placebo in the risk of subtrochanteric/diaphyseal fractures during the FIT, FIT Long-Term Extension (FLEX) or HORIZON-PFT trials. Compared with

placebo, the relative hazard was 1.03 (95% CI 0.1–16.5) for alendronate use in the FIT trial, 1.5 (95% CI 0.3–9.0) for zoledronic acid in the HORIZON-PFT and 1.3 (95% CI 0.1–14.7) for continued alendronate use in the FLEX trial. The interpretation of this analysis is limited by the small number of AZD6244 clinical trial events and the large confidence intervals. Table 3 Characteristics of ten patients with 12 low-trauma subtrochanteric or femoral diaphyseal fractures in the FIT, FLEX and HORIZON-PFT trials (adapted from Black et al. [69]) Study Age (years) Study medication Time from randomization to fracture (days [years]) Bilateral? ID-8 Prodromal symptoms Compliance Concomitant therapy FIT 75 Placebo 962 (2.6)     >75% None FIT 69 Alendronate 1,682 (4.6)     >75% None EPZ015938 purchase FLEX 79 Alendronate (first fracture) 1,250 (3.4)     Stopped 3 years before first fracture Alendronate, 6 years (in FIT before FLEX) Alendronate (second fracture) 1,369 (3.8) FLEX 80 Alendronate/placebo 1,257 (3.4)     Stopped 3 years before fracture Alendronate, 6 years (in FIT before FLEX) FLEX 83 Alendronate/alendronate 1,006 (2.8)     >75% Alendronate, 5 years (in FIT before FLEX) HORIZON 65 Zoledronic acid 454 (1.2)  

Hip pain 100% Raloxifene HORIZON 78 Placebo 1,051 (2.9)   Hip pain 100% None HORIZON 65 Zoledronic acid 732 (2.0)     100% None HORIZON 72 Placebo 321 (0.9)     100% Calcitonin HORIZON 71 Zoledronic acid (2 fractures) 934 (2.6) Yes Bone pain 100% Bisphosphonate and hormone replacement therapy, both before study Bilezikian et al. reported the incidence of subtrochanteric fractures in the randomized, placebo-controlled phase III studies of risedronate in post-menopausal osteoporosis, which enrolled more than 15,000 patients. In trials of up to 3 years duration, the mean incidence of subtrochanteric fractures was 0.14% in risedronate 2.5-mg treated patients (n = 4,998), 0.13% in risedronate 5-mg treated patients (n = 5,395) and 0.17% in placebo-treated patients (n = 5,363) [70].

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