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Alendronate Beneficial for Women with Both Natural and Surgical Menopause: Presented at NAMS

By Deanna M Green, PhD

MIAMI BEACH, FL -- September 29, 2003 -- Alendronate is effective at increasing bone mineral density (BMD), both in women with naturally occurring menopause and those with surgically induced menopause, according to findings presented here September 18^th at the 14^th Annual Meeting of The North American Menopause Society.

Most studies on osteoporosis in postmenopausal women have included both women who naturally entered menopause and those whose menopause was induced by surgery (such as bilateral oophorectomy). However, important differences exist between these groups that have not been addressed by these studies.

Alendronate is one treatment option for osteoporosis that has been shown to be effective in postmenopausal women. Similarly, hormone therapy has beneficial effects on BMD. The effectiveness of both of these therapies with respect to menopause induction has not yet been studied, however.

James A Simon, MD, George Washington University, Washington, District of Columbia, United States, and colleagues therefore evaluated the effects of alendronate and hormone replacement on BMD in naturally and surgically induced menopausal women.

The study included two randomised clinical trials. The first trial enrolled non-osteoporotic, naturally menopausal women who were randomised to receive alendronate, conjugated equine oestrogen (0.625 mg/day) and progestin, or placebo for 4 years followed by a 2-year withdrawal period. The second study included osteoporotic women (average lumbar spine T score -2.5) with surgically induced menopause who were randomised to receive alendronate, unopposed conjugated equine oestrogen (0.625 mg/day), or placebo for 2 years, followed by a 1 year without treatment.

In surgically induced menopausal women, alendronate and hormone therapy caused almost identical increases in both spine and hip BMD during treatment. Further analysis of the net change in spine BMD, though, indicated that alendronate was superior to hormone therapy in these women.

During the withdrawal period, the benefits seen with alendronate were maintained, while the benefits of hormone therapy rapidly declined; specifically, lumbar spine BMD decreased by 4.5% after hormone therapy, yet showed no significant loss after alendronate treatment.

The same trend during treatment and withdrawal was observed in women with natural menopause. Although hormone therapy showed somewhat greater improvement in BMD than alendronate during treatment, it also showed greater decline after treatment (7.7%).

Dr. Simon concluded that "alendronate and hormone therapy have similar skeletal effects during therapy in natural and surgical menopausal women." He emphasized, however, that only the alendronate skeletal benefits persist after discontinuation.


[Study title: Consistent alendronate skeletal benefits in postmenopausal women with natural or surgical menopause. Abstract S2]

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