BoneKEy Reports | BoneKEy Watch
Osteoporosis drugs most effective in women at high fracture risk
DOI:10.1038/bonekey.2012.124
Ibandronate, basedoxifene, strontium ranelate and other osteoporosis drugs may be more efficient at reducing non-vertebral and hip fractures in women in high risk vs. lower risk groups. In the pivotal trial FREEDOM, denosumab reduced non-vertebral fractures by 20% and hip fractures by 40% overall, but post hoc analyses have suggested that the relative risk reduction in high risk women was potentially much greater. Primary data from FREEDOM have now been further analyzed to determine whether fracture probability, as measured using the FRAX tool, correlated with drug efficacy.
Denosumab was clearly more effective at reducing fracture risk in women who were at moderate to high risk of fractures compared with those at low risk. For example, in women with a 10% probability of fracture, denosumab treatment decreased fracture risk by 11% (P=0.629). In women with a 30% probability of fracture, the reduction was greater, and reached significance at 50% (P=0.001).
Editor's comment: This FRAX analysis confirms that the benefits of denosumab increase with a higher baseline probability of fracture. The trend emerging from several published observations is that most osteoporosis drugs are able to reduce clinical fractures with greatest efficacy when the probability of osteoporotic fractures (estimated by FRAX) exceeds 15% over 10 years. This is important clinical information and it also has economic implications.
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