Journal Facts

Journal
BoneKEy Knowledge Environment
ISSN
1533-4368
Volume
Year
2002

Article Facts

Title
Alendronate in the institutionalized elderly
DOI
10.1138/2002047
Author

Online Date
06/26/2002

Article Links

BoneKEy-Osteovision | Commentary

Alendronate in the institutionalized elderly


DOI:10.1138/2002047

Commentary on: Greenspan SL, Schneider DL, McClung MR, Miller PD, Schnitzer TJ, Bonin R, Smith ME, DeLucca P, Gormley GJ, Melton ME. Alendronate improves bone mineral density in elderly women with osteoporosis residing in long-term care facilities. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2002 May 21;136(10):742-6.

Are bisphosphonates useful medications for the treatment of osteoporosis in frail elderly patients who are institutionalized? Are they effective and are they tolerated? Greenspan and colleagues report the results of a study of 327 elderly women with osteoporosis who were randomized to receive alendronate (Fosamax) 10 mg daily vs placebo (). The mean age of subjects was 78.5, and they were allowed to be in the study if they were taking aspirin or NSAIDS or had upper gastrointestinal disease unless there was recent major upper gastrointestinal erosive disease. All women took 400 IU of vitamin D daily, and those with low intakes of calcium received supplements. Results for BMD and markers of bone turnover were similar to that reported in previous studies such as FIT (); increases of around 7% at the spine and around 4% at the hip, and decreases of 60% in urinary NTX. Like the FIT trial, this study reports that the incidence of upper gastrointestinal side effects was high but comparable in the patients treated with placebo or alendronate (35 and 33% respectively). More patients receiving placebo had a fracture during the study, but the difference between groups (11% in the placebo group and 8% in the alendronate group) was not significant.

The most noteworthy conclusion from this study is that alendronate has the same effects in elderly subjects as has previously been reported in younger subjects. We can be reassured that in the population studied, elderly subjects who may have gastrointestinal problems and take other gastrointestinal irritants, the drug works well and seems as well-tolerated as placebo. Since not many of the subjects were from nursing homes, one may not necessarily be able to extrapolate these results to elderly patients institutionalized in nursing homes.

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