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Previous Volume 344:333-340 February 1, 2001 Number 5 Next

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ABSTRACT

Background Risedronate increases bone mineral density in elderly women, but whether it prevents hip fracture is not known.

Methods We studied 5445 women 70 to 79 years old who had osteoporosis (indicated by a T score for bone mineral density at the femoral neck that was more than 4 SD below the mean peak value in young adults [–4] or lower than –3 plus a nonskeletal risk factor for hip fracture, such as poor gait or a propensity to fall) and 3886 women at least 80 years old who had at least one nonskeletal risk factor for hip fracture or low bone mineral density at the femoral neck (T score, lower than –4 or lower than –3 plus a hip-axis length of 11.1 cm or greater). The women were randomly assigned to receive treatment with oral risedronate (2.5 or 5.0 mg daily) or placebo for three years. The primary end point was the occurrence of hip fracture.

Results Overall, the incidence of hip fracture among all the women assigned to risedronate was 2.8 percent, as compared with 3.9 percent among those assigned to placebo (relative risk, 0.7; 95 percent confidence interval, 0.6 to 0.9; P=0.02). In the group of women with osteoporosis (those 70 to 79 years old), the incidence of hip fracture among those assigned to risedronate was 1.9 percent, as compared with 3.2 percent among those assigned to placebo (relative risk, 0.6; 95 percent confidence interval, 0.4 to 0.9; P=0.009). In the group of women selected primarily on the basis of nonskeletal risk factors (those at least 80 years of age), the incidence of hip fracture was 4.2 percent among those assigned to risedronate and 5.1 percent among those assigned to placebo (P=0.35).

Conclusions Risedronate significantly reduces the risk of hip fracture among elderly women with confirmed osteoporosis but not among elderly women selected primarily on the basis of risk factors other than low bone mineral density.

Risedronate (Actonel, Procter & Gamble, Cincinnati), a pyridinyl bisphosphonate, decreases the risk of vertebral and nonvertebral fractures in postmenopausal women with osteoporosis.^14,15 We conducted a clinical trial designed to evaluate the effects of risedronate on the risk of hip fracture in elderly women with osteoporosis or with risk factors for hip fracture other than low bone mineral density.

Methods

Study Design and Subjects

The study was conducted between November 1993 and April 1998. We enrolled two groups of ambulatory postmenopausal women in two identical protocols at 183 study centers in North America, Europe, New Zealand, and Australia. One group consisted of women 70 to 79 years old who had osteoporosis, indicated by either a bone mineral density at the femoral neck (T score) that was more than 4 SD below the mean peak value in young adults (–4) or a femoral-neck T score lower than –3 plus at least one risk factor for hip fracture. These risk factors (hereafter referred to as clinical risk factors) included difficulty standing from a sitting position, a poor tandem gait, a fall-related injury during the previous year, a psychomotor score of 5 or less on the Clifton Modified Gibson Spiral Maze test (a test of hand–eye coordination, with scores ranging from 1 to 12, where scores of 5 or less are considered to indicate an increased risk of falling),¹⁶ current smoking or smoking during the previous five years, a maternal history of hip fracture, a previous hip fracture, and a hip-axis length of 11.1 cm or greater. The other group consisted of women 80 years of age or older who had at least one nonskeletal risk factor for hip fracture, a femoral-neck T score lower than –4, or a femoral-neck T score lower than –3 plus a hip-axis length of 11.1 cm or greater. For purposes of enrollment, femoral-neck T scores were calculated according to the densitometer's manufacturer's reference data base. The femoral-neck T scores at base line were later recalculated according to reference data from the Third National Health and Nutrition Examination Survey.¹⁷ The women identified their race.

The exclusion criteria were any major medical illness, a recent history of cancer, another metabolic bone disease within the previous year, important abnormalities in the results of routine laboratory tests, recent use of drugs known to affect bone, allergy to any bisphosphonate, a history of bilateral hip fractures, and any physical or mental condition that would preclude participation in a clinical trial. There were no specific criteria for exclusion on the basis of previous or ongoing upper gastrointestinal tract disorders or concomitant use of nonsteroidal antiinflammatory drugs, aspirin, proton-pump inhibitors, or antacids.

The women in each of the two enrollment groups were randomly assigned to take either a 2.5-mg or a 5.0-mg risedronate tablet or an identical-appearing placebo tablet daily for three years. The women were instructed to take the tablets with a cup (240 ml) of water on an empty stomach, 30 to 60 minutes before breakfast, and to remain upright for 60 minutes thereafter. The women also received supplemental calcium carbonate (1000 mg of elemental calcium daily) to be taken with the midday or evening meal. Vitamin D (500 IU daily) was given if the serum 25-hydroxyvitamin D concentration at the time of screening was below 16 ng per milliliter (40 nmol per liter), as determined at one of the two central laboratories (Quintiles [Smyrna, Ga.] for the North American study centers and Bioanalytical Research [Ghent, Belgium] for the other study centers). The protocol was approved by the ethics committee or institutional review board at each center, and all the women gave written informed consent.

Measurements of Efficacy

The primary end point was the incidence of radiographically confirmed hip fractures. A secondary end point was the incidence of nonvertebral osteoporotic fractures, defined as all radiographically confirmed fractures of the wrist, leg, humerus, hip, pelvis, or clavicle. Bone mineral density, another secondary end point, was measured at base line and at six-month intervals by dual-energy x-ray absorptiometry with a densitometer (Lunar, Madison, Wis., or Hologic, Waltham, Mass.) in the women who were enrolled at 44 of the study centers. The scans were obtained according to procedures established by a central analysis and quality-assurance facility (Oregon Osteoporosis Center, Portland). The presence or absence of a vertebral fracture at base line was determined by examination of spinal radiographs, according to published methods.¹⁸

Assessments of Adverse Events

The women underwent physical examinations at the beginning and end of the study. Hematologic tests and tests of serum chemistry were performed and information about adverse events was collected at regular intervals during the study.

Statistical Analysis

Women who received at least one dose of either risedronate or placebo were included in the analysis. Women who discontinued treatment before the end of the three-year treatment period were requested to return to their study center at the time of the scheduled third-year visit. We performed analyses of fractures that occurred during the treatment period as well as those that occurred during treatment or follow-up. We planned to compare the women who were assigned to risedronate at each dose with those assigned to placebo. However, because the incidence of hip fractures was lower than expected and because another study of risedronate showed that both a 2.5-mg dose and a 5.0-mg dose were effective in reducing the risk of vertebral fractures,¹⁴ we modified the analysis of efficacy and compared the women assigned to risedronate at either dose with those assigned to placebo.

Because two groups of women (those with confirmed osteoporosis and those with primarily nonskeletal risk factors) were enrolled, we undertook a prospective analysis of the data according to the enrollment group. On the basis of data indicating that the presence of a vertebral fracture at base line affects the subsequent incidence of hip fractures in women with low bone mineral density at the femoral neck,^5,6 we performed a retrospective analysis of the risk of fracture among the women 70 to 79 years old who had a history of vertebral fracture.

The incidence of hip fracture was calculated with use of Kaplan–Meier survival estimates. The log-rank test was used to test the significance of differences between treatment groups. P values were not corrected for multiple comparisons. Proportional-hazards regression analysis was used to estimate the relative risk (with the 95 percent confidence interval) of hip fracture in the risedronate group as compared with the placebo group; nonvertebral fractures were analyzed by similar methods. Comparisons of the percent change from base line in bone mineral density according to treatment assignment were performed by analysis of variance. All tests were two-sided.

Results

Characteristics of the Subjects

A total of 9331 women were enrolled in the study and received at least one dose of study medication (Figure 1). Within each enrollment group, the base-line characteristics of those assigned to risedronate and those assigned to placebo were similar (Table 1). Measurements of bone mineral density were available at base line for only 31 percent of the women 80 years of age or older. Almost all the women (98 percent) were white.

View larger version (26K): [in this window] [in a new window]   Figure 1. Design of the Study. Women 70 to 79 years of age were enrolled if they had a low bone mineral density at the femoral neck (T score, lower than –4 or lower than –3 with at least one nonskeletal risk factor for hip fracture). Women 80 years of age were enrolled if they had at least one nonskeletal risk factor for hip fracture or a low bone mineral density at the femoral neck (T score, lower than –4 or lower than –3 with a hip-axis length 11.1 cm). The following numbers of women had withdrawn by 12, 24, and 36 months: 842, 1365, and 1677 of the women 70 to 79 years old and 820, 1317, and 1647 of the women 80 years of age or older. Some women stopped taking their assigned treatment before the end of the study but were followed until the end of the study (i.e., completed follow-up).

 

View this table: [in this window] [in a new window]   Table 1. Base-Line Characteristics of the Women in the Study, According to Age at Enrollment.

 
Complete follow-up data were available for 64 percent of the women (69 percent of those with confirmed osteoporosis and 58 percent of those with mainly clinical risk factors). The duration of follow-up was similar for the women assigned to risedronate and those assigned to placebo (mean, 2.3 years), as was the mean duration of therapy (2.0 years). The clinical characteristics, including the bone mineral density at the femoral neck, of the women who discontinued treatment early and of those who received treatment for all three years of the study were similar, except that the former tended to be slightly older and to weigh less and were more likely to smoke than the latter. There were no significant differences between the women assigned to risedronate and those assigned to placebo with respect to the reasons for discontinuation of treatment (data not shown).

Hip Fractures

Of the 9331 women who received at least one dose of study medication, 232 had a hip fracture. Of these fractures, 60 percent were at the femoral neck, 33 percent were intertrochanteric, 3 percent were at the femoral head, and no specific information on the site of the fracture was available for 4 percent. In an analysis of all women, the incidence of hip fracture was 2.8 percent among the women assigned to risedronate, as compared with 3.9 percent among those assigned to placebo (Table 2).

View this table: [in this window] [in a new window]   Table 2. Incidence of Hip Fracture in Subgroups of the Women, According to Treatment with Risedronate or Placebo.

 
The incidence of hip fracture in the group of women 70 to 79 years old was 1.9 percent among those assigned to risedronate and 3.2 percent among those assigned to placebo (relative risk, 0.6; 95 percent confidence interval, 0.4 to 0.9; P=0.009) (Table 2 and Figure 2A). In this younger group, the effects of the 2.5-mg and 5.0-mg doses of risedronate were similar; the relative risk of hip fracture for the 2.5-mg dose was 0.5 (95 percent confidence interval, 0.3 to 0.9) and that for the 5.0-mg dose was 0.7 (95 percent confidence interval, 0.4 to 1.1). Information on the presence or absence of a history of vertebral fracture at base line was available for 4351 of the younger women, 1703 (39 percent) of whom had evidence of at least one vertebral fracture at base line. Among the latter women, the relative risk of hip fracture associated with risedronate treatment was 0.4 (95 percent confidence interval, 0.2 to 0.8; P=0.003). Among the younger women who were known not to have a history of vertebral fracture at base line, the relative risk was 0.6 (95 percent confidence interval, 0.3 to 1.2; P=0.14).

View larger version (18K): [in this window] [in a new window]   Figure 2. Kaplan–Meier Estimates of the Incidence of Hip Fracture in the Younger Women (Panel A) and the Older Women (Panel B), According to Treatment with Risedronate or Placebo. Women 70 to 79 years old were enrolled if they had a low bone mineral density at the femoral neck (T score, lower than –4 or lower than –3 with at least one nonskeletal risk factor for hip fracture). Women 80 years of age or older were enrolled if they had at least one nonskeletal risk factor or a low bone mineral density at the femoral neck (T score, lower than –4 or lower than –3 with a hip-axis length 11.1 cm).

 
In the group of women 80 years of age or older, risedronate had no effect on the incidence of hip fracture (Table 2 and Figure 2B). The majority (58 percent) of the women in this group were recruited solely on the basis of clinical risk factors, such as a recent fall-related injury; only 16 percent were recruited on the basis of low bone mineral density at the femoral neck. Information on bone mineral density was not available for most of the women in this age group. Among the 1313 older women who were assigned to the placebo group, 316 were known to have osteoporosis (T score, –2.5 or lower according to reference data from the Third National Health and Nutrition Examination Survey; mean T score, –3.3). The incidence of hip fracture among the women with confirmed osteoporosis was 9.7 percent, as compared with 5.6 percent among the 89 women without osteoporosis (T score, higher than –2.5) and 3.6 percent among the 908 women whose bone mineral density was not known. Among the 941 older women who were known to have low bone mineral density (T score, –2.5 or lower), the incidence of hip fracture was 7.2 percent among those assigned to risedronate and 9.7 percent among those assigned to placebo (P=0.37).

Nonvertebral Fractures

In an analysis of all the women, the incidence of nonvertebral fractures was 9.4 percent among those assigned to risedronate, as compared with 11.2 percent among those assigned to placebo (relative risk, 0.8; 95 percent confidence interval, 0.7 to 1.0; P=0.03). When only the women with confirmed osteoporosis were considered, the incidence of nonvertebral fractures among those assigned to risedronate was 8.4 percent, as compared with 10.7 percent among those assigned to placebo (relative risk, 0.8; 95 percent confidence interval, 0.7 to 1.0; P=0.03). Among the women in this enrollment group who had a vertebral fracture at base line, the incidence of nonvertebral fracture was 10.3 percent among those assigned to risedronate, as compared with 16.1 percent among those assigned to placebo (relative risk, 0.7; 95 percent confidence interval, 0.5 to 0.9; P=0.01). Among the women selected primarily on the basis of nonskeletal risk factors, the treatment assignment had no effect on the incidence of nonvertebral fracture (10.8 percent with risedronate, as compared with 11.9 percent with placebo; P=0.43).

Bone Mineral Density

Bone mineral density was measured during treatment in a total of 1765 women (19 percent of those who received at least one dose of study medication), including 1236 of the women in the younger enrollment group, who had confirmed osteoporosis, and 529 of those in the older group. In the younger group, the mean bone mineral density at the femoral neck and trochanter among those assigned to risedronate was higher at six months than at base line and was higher than the mean value among those assigned to placebo at six months and at all time points thereafter. At three years, the bone mineral density at the femoral neck in this group was 2.1 percent and 3.4 percent higher among the women assigned to 2.5 mg and 5.0 mg of risedronate, respectively, than among those assigned to placebo, and the bone mineral density at the trochanter was 3.8 percent and 4.8 percent higher, respectively. At three years there was no change in the bone mineral density at either site among the younger women assigned to placebo. These changes in bone mineral density were similar to those observed in the older enrollment group (data not shown).

Adverse Events

In an analysis of all the women, the proportion of women who had any adverse event, who had a serious adverse event, or who withdrew because of an adverse event was similar regardless of treatment assignment (Table 3). The incidence of adverse events involving the upper gastrointestinal tract was similar among the women assigned to risedronate and those assigned to placebo.

View this table: [in this window] [in a new window]   Table 3. Adverse Events during the Study.

 
The women in the older enrollment group, who ranged in age from 80 to 100 years, had a slightly higher incidence of death, other serious adverse events, and withdrawals due to adverse events than the younger women. However, the overall frequency and types of adverse events, including those involving the upper gastrointestinal tract, were similar in the risedronate and placebo groups, regardless of age (data not shown).

Discussion

In this large trial, risedronate prevented hip fractures in the women who had osteoporosis, indicated by a low bone mineral density at the femoral neck, but not in the women who, although they had clinical risk factors for hip fracture, did not necessarily have osteoporosis.

In the group of women with confirmed osteoporosis (those 70 to 79 years old), the observed incidence of hip fracture among those assigned to placebo (3.2 percent during the three-year study) was higher than the reported 0.6 to 0.8 percent annual incidence in unselected, untreated women of the same age,^19,20 indicating that our selection criterion of a low bone mineral density at the femoral neck successfully identified women at increased risk for hip fracture. In the group of women with confirmed osteoporosis, the incidence of hip fracture among those assigned to placebo was substantially higher among the women with a previous vertebral fracture than among those without a previous vertebral fracture (5.7 percent and 1.6 percent, respectively, during the three-year study), confirming earlier findings that a previous vertebral fracture increases the risk of hip fracture.²¹ The absence of a significant effect of risedronate in the women with low bone mineral density at the femoral neck but no history of vertebral fracture is probably due to the low incidence of hip fracture and the small number of women in this group.

Our data indicating that the risk of hip fracture decreases with use of risedronate are consistent with those previously reported in trials of alendronate^5,6; in those studies, low bone mineral density at the femoral neck and previous vertebral fracture identified women who benefited from treatment. Supplementation with calcium and vitamin D have been reported to reduce bone loss and the risk of nonvertebral fracture in ambulatory men and women over 65 years of age²² and to reduce the risk of hip fracture among women in nursing homes.^23,24 Because supplementation with calcium and vitamin D was provided to the women in this study, the effects of risedronate treatment occurred in addition to any benefit attributable to the supplementation.

The incidence of hip fracture among the older women who were assigned to placebo, who had mainly clinical risk factors, was higher than that among the younger women assigned to placebo, all of whom had confirmed osteoporosis, but it was similar to that previously reported in other groups of untreated women of similar age.^19,20 The fact that the incidence was not higher in our study may be explained by the effect of the calcium and vitamin D supplementation. It is also possible that our enrollment criteria, which allowed older women with a single clinical risk factor for hip fracture to enter the study, did not adequately identify women at increased risk of fracture, since the presence of multiple clinical risk factors more strongly predicts the risk of hip fracture than does the presence of single risk factors.⁷

Evaluation of the role of bone mineral density at the femoral neck in predicting the response to treatment among women 80 years of age or older is confounded by the facts that few of these older women were recruited on the basis of a low bone mineral density at the femoral neck and that this measurement was not available in most of these women. Among the women 80 years of age or older who were assigned to placebo, the incidence of hip fracture among those without data on bone mineral density was similar to that among those known to have T scores greater than –2.5 at the femoral neck, suggesting that the majority of the older women did not have osteoporosis.

Risedronate treatment was well tolerated in our study. Overall, the incidence and types of adverse events were similar to those observed with use of placebo, even among women 80 years of age or older. These data confirm the favorable safety profile of risedronate observed in relatively young patients in previous studies.^14,15 Fifty percent of the women completed three years of treatment, although 64 percent had complete follow-up data for the three-year study. The women who discontinued treatment early may have been at higher risk for hip fracture, since they were older, thinner, and more likely to smoke than those who completed treatment. The effect of their discontinuation of treatment would be to limit the magnitude of the treatment effect by decreasing the exposure of the treated group to the study drug. The results of the analysis of hip fracture were similar whether or not the hip fractures occurring during the follow-up period were included. The reasons for discontinuation of treatment and the adverse events associated with discontinuation among the women assigned to risedronate were similar to those among the women assigned to placebo, suggesting that poor drug tolerability was not a factor in the discontinuation of treatment.

Our results demonstrate the importance of measurements of bone mineral density in identifying women for whom drug therapy to prevent hip fracture is appropriate. Risedronate treatment reduces the risk of hip fracture among women with osteoporosis, defined as a low bone mineral density at the femoral neck, but it is not more effective than calcium and vitamin D alone in women identified primarily on the basis of clinical risk factors for hip fracture. Women with the most advanced disease (as evidenced by a low bone mineral density at the femoral neck and a history of vertebral fractures) may benefit the most from risedronate treatment.

Supported by grants from Procter & Gamble Pharmaceuticals (Cincinnati) and Aventis Pharma (Bridgewater, N.J.).

The authors have received research grants from or have served as consultants to or members of speakers' bureaus for Procter & Gamble, Aventis Pharma, and other companies that make products used in the treatment of osteoporosis.

We are indebted to Simon Pack, Ph.D., and Joseph DiGennaro, M.S., for statistical analyses; to Lisa Bosch for assistance in the preparation of the manuscript; to the members of the support staff at the study centers for their contributions; and to the women who participated in the study.

^* Other investigators in the Hip Intervention Program Study Group are listed in the Appendix.

Source Information

From the Oregon Osteoporosis Center and Providence Medical Center, Portland (M.R.M.); Limburg University Center, Diepenbeek, Belgium, and the University of Maastricht, Maastricht, the Netherlands (P.G.); Colorado Center for Bone Research, Lakewood (P.D.M.); Humboldt Universität Berlin Charité, Berlin, Germany (H.Z.); St. Joseph's Hospital, McMaster University, Hamilton, Ont., Canada (W.G.B.); Hôpital Cochin, Paris (C.R.); Centro Ospedaliero, Clinicizzato di Valeggio, Valeggio, Italy (S.A.); Guy's Hospital, London (I.F.); St. George Hospital, Kogarah, N.S.W., Australia (T.D.); the University of Sheffield, Sheffield, United Kingdom (R.E.); Edouard Herriot Hôpital, Lyons, France (P.J.M.); Hawaii Osteoporosis Center, Honolulu, Hawaii (R.D.W.); Osteoporosis Medical center, Palm Springs, Calif. (M.G.); Universitair Ziekenhuis, Ghent, Belgium (J.-M.K.); University of Washington, Seattle, Wash. (C.H.C.); and the University of Liège, Liège, Belgium (J.-Y.R.).

Address reprint requests to Dr. McClung at the Oregon Osteoporosis Center, 5050 N.E. Hoyt, Suite 651, Portland, OR 97213, or at mmcclung{at}oregonosteoporosis.com.

References

1. Chrischilles EA, Butler CD, Davis CS, Wallace RB. A model of lifetime osteoporosis impact. Arch Intern Med 1991;151:2026-32. [Erratum, Arch Intern Med 1992;152:655.] 
2. Cauley JA, Seeley DG, Ensrud K, Ettinger B, Black D, Cummings SR. Estrogen replacement therapy and fractures in older women: Study of Osteoporotic Fractures Research Group. Ann Intern Med 1995;122:9-16. [Free Full Text]
3. Hutchinson TA, Polansky SM, Feinstein AR. Post-menopausal oestrogens protect against fractures of hip and distal radius: a case-control study. Lancet 1979;2:705-709. [Web of Science][Medline]
4. Kiel DP, Felson DT, Anderson JJ, Wilson PWD, Moskowitz MA. Hip fracture and the use of estrogens in postmenopausal women: the Framingham Study. N Engl J Med 1987;317:1169-1174. [Abstract]
5. Black DM, Cummings SR, Karpf DB, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 1996;348:1535-1541. [CrossRef][Web of Science][Medline]
6. Cummings SR, Black DM, Thompson DE, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 1998;280:2077-2082. [Free Full Text]
7. Cummings SR, Nevitt MC, Browner WS, et al. Risk factors for hip fracture in white women. N Engl J Med 1995;332:767-773. [Free Full Text]
8. Nguyen T, Sambrook P, Kelly P, et al. Prediction of osteoporotic fractures by postural instability and bone density. BMJ 1993;307:1111-1115.
9. Schott AM, Cormier C, Hans D, et al. How hip and whole-body bone mineral density predict hip fracture in elderly women: the EPIDOS Prospective Study. Osteoporos Int 1998;8:247-254. [CrossRef][Web of Science][Medline]
10. Dargent-Molina P, Favier F, Grandjean H, et al. Fall-related factors and risk of hip fracture: the EPIDOS prospective study. Lancet 1996;348:145-9. [Erratum, Lancet 1996;348:416.]
11. Cumming RG, Klineberg RJ. Case-control study of risk factors for hip fractures in the elderly. Am J Epidemiol 1994;139:493-503. [Free Full Text]
12. Law MR, Hackshaw AK. A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect. BMJ 1997;315:841-846. [Free Full Text]
13. Ensrud KE, Lipschutz RC, Cauley JA, et al. Body size and hip fracture risk in older women: a prospective study. Am J Med 1997;103:274-280. [CrossRef][Web of Science][Medline]
14. Reginster J-Y, Minne HW, Sorensen OH, et al. Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Osteoporos Int 2000;11:83-91. [CrossRef][Web of Science][Medline]
15. Harris ST, Watts NB, Genant HK, et al. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized, controlled trial. JAMA 1999;282:1344-1352. [Free Full Text]
16. Pattie AH, Gilleard CJ. Manual of the Clifton Assessment Procedures in the Elderly (CAPE). London: Hodder and Stoughton Educational, 1979.
17. Looker AC, Johnston CC Jr, Wahner HW, et al. Prevalence of low femoral bone density in older U.S. women from NHANES III. J Bone Miner Res 1995;10:796-802. [Web of Science][Medline]
18. Melton LJ III, Lane AW, Cooper C, Eastell R, O'Fallon WM, Riggs BL. Prevalence and incidence of vertebral deformities. Osteoporos Int 1993;3:113-119. [CrossRef][Web of Science][Medline]
19. Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int 1997;7:407-413. [CrossRef][Web of Science][Medline]
20. Melton LJ III, Chrischilles EA, Cooper C, Lane AW, Riggs BL. How many women have osteoporosis? J Bone Miner Res 1992;7:1005-1010. [Web of Science][Medline]
21. Kotowicz MA, Melton LJ III, Cooper C, Atkinson EJ, O'Fallon WM, Riggs BL. Risk of hip fracture in women with vertebral fracture. J Bone Miner Res 1994;9:599-605. [Web of Science][Medline]
22. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 1997;337:670-676. [Free Full Text]
23. Chapuy MC, Arlot ME, Duboeuf F, et al. Vitamin D₃ and calcium to prevent hip fractures in elderly women. N Engl J Med 1992;327:1637-1642. [Abstract]
24. Chapuy MC, Arlot ME, Delmas PD, Meunier PJ. Effect of calcium and cholecalciferol treatment for three years on hip fractures in elderly women. BMJ 1994;308:1081-1082. [Free Full Text]

Other members of the Hip Intervention Program Study Group are as follows: Australia — Concord, N.S.W.: M. Hooper; Darlinghurst, N.S.W.: J. Freund; Heidelberg, Victoria: E. Seeman; Herston, Queensland: D. Perry-Keene; Parkville, Victoria: L. Flicker; and Randwick, N.S.W.: D. Calligeros. Belgium — Brussels: T. Appelboom, J. Brody, and J.P. Devogelaer; Pellenberg: J. Dequeker; and Tessenderloo: M. Walravens. France — Amiens: P. Andreuix; Carcassonne: G. Morlock; Gonnesse: J. Glowinski; Ivry-sur-Seine: F. Piette; Lille: B. Duquesnoy; Nimes: B. Combe; Orleans: C. Benhamou; Paris: C. Menkes; Rouen: A. Daragon; Toulouse: B. Vellas; and Tours: P. Goupille. Germany — Aachen: T. Ittel; Bad Pyrmont: H.W. Minne; Bad Waldsee: P. Maier; Bochum: R. Adernak and P. Michalke; Regensburg: F. Osthoff; Kassel: M. Fischer; and Munich: K. Kolb. Italy — Genoa: G. Rovetta; Naples: A. Tricarico; Parma: M. Passeri; Pisa: O. DiMunno; Rome: R. Bernabei; and Siena: C. Gennari. The Netherlands — Rotterdam: J. Jonker and H. Mulder. New Zealand — Christchurch: N. Gilchrist; and Dunedin: P. Manning. Switzerland — Geneva: R. Rizzoli. United Kingdom — Aberdeen: D.M. Reid; Appley Bridge, Wigan: I.G. Smith; Bath: A.K. Bhalla; Cannock, Staffordshire: T. Price; Cheadle Hulme, Cheshire: J.E. Miller; Cleckheaton, West Yorkshire: J.B. Frazer; Didcot, Oxfordshire: J. Spiro; Dublin: O. Fitzgerald, M. McKenna, M. O'Brien, D. Powell, and E. Swaine; Gillingham, Kent: P. Ryan; Glasgow: A.D. Bremner, G. Crawford, P.E. McGill, and A. McLellan; Hove, Sussex: R.J. Burwood; Hull: S.M. Doherty; London: D. Doyle and T. Spector; Newport, Gwent: J.H. Beynon; Oswestry, Shropshire: M.W.J. Davie; Oxford: R. Smith; Poole, Dorset: P.W. Thompson; South Glamorgan, Wales: K.W. Woodhouse; Southampton, Hampshire: C. Cooper; Tadworth, Surrey: P.C. Stott; Truro, Cornwall: A.D. Woolf; and Wilton, Cork: M. Molloy. United States — Akron, Ohio: W. Wojno; Albuquerque, N.M.: J. Gleeson; Altamonte Springs, Fla.: R. Graham; Altoona, Pa.: A.J. Kivitz; Atlanta: S. Funk and S. Gordon; Baltimore: F.M. Gloth and T. Zizic; Beachwood, Ohio: C. Deal; Beverly Hills, Calif.: S. Silverman; Billings, Mont.: S. English; Birmingham, Ala.: L. Moreland; Boulder, Colo.: M. Stjernholm; Boynton Beach, Fla.: M. Jurado, B. Schultz, I. Weisberg, and M. Westle; Burlington, Vt.: E. Leib; Charlotte, N.C.: J. Box, W. Gruhn, and H. Hinshaw; Chicago: H. Black; Cincinnati: R. Bath and J. Fidelholtz; Columbia, S.C.: R. Collins; Columbus, Ohio: R. Jackson, D. Schumacher, and J. Smucher; Dallas: R. Fleischmann; Concord, Calif.: R. Kaplan; Cooperstown, N.Y.: J. Rockwell; Dayton, Ohio: R. Coalson and J. Randall; Decatur, Ga.: G. Woodson III; Des Moines, Iowa: T. Rooney; East Lansing, Mich.: J. Fiechtner; Fairfield, N.J.: J. Liotti; Fall River, Mass.: R. Rapoport; Fort Myers, Fla.: F. Schaerf; Gainesville, Fla.: M. Heuer and M. Notelovitz; Gaithersburg, Md.: M. Bolognese; Greer, S.C.: W.T. Ellison; Hamden, Conn.: R. Lang; Hampton, Va.: S. Green; Hollywood, Fla.: W. Riskin; Houston: C.D. McKeever; Huntsville, Ala.: W.J. Shergy; Indianapolis: R. Khairi; Irvine, Calif.: S. Rosenblatt; Jackson, Miss.: S. Songcharoen; Jacksonville, Fla.: Y. Coble; Kalamazoo, Mich.: J. Juozevicius and G. Ruoff; Lancaster, Pa.: M. Wenger; Lexington, Ky.: N. Farris; Little Rock, Ark.: M. Miller; Loma Linda, Calif.: D. Baylink; Longmont, Colo.: D. Podlecki; Louisville, Ky.: S. Stern; Madison, Wis.: T. Harrington; Medford, Oreg.: H.W. Emori; Newark, Del.: D. Burge and S. Javed; Norfolk, Va.: A. Lee; Olympia, Wash.: R. Levy; Olympia Fields, Ill.: H. Hedavati; Orlando, Fla.: J. Poiley; Owings Mills, Md.: E. Pavlov; Paradise Valley, Ariz.: P. Howard; Park Ridge, Ill.: S. Broy; Peabody, Mass.: M.D. Heller; Philadelphia: B. Freundlich and A. Mangione; Phoenix, Ariz.: M. Block and S. Roth; Providence, R.I.: W. Brown and J. Tucci; Rancho Cucamonga, Calif.: E. Boling; Riverdale, Md.: M.B. Rao; Rochester, N.Y.: M. Hooper; Sacramento, Calif.: T. Melchione and M. Parr; St. Louis: R. Civitelli; Salisbury, Mass.: M. McCartney; San Antonio, Tex.: F.X. Burch and S. Schwartz; San Diego, Calif.: M. Keller; San Francisco: S.T. Harris; South Yarmouth, Mass.: P. Ripley; Springfield, Ill.: R. Trapp; St. Petersburg, Fla.: M. Farmer; Stamford, Conn.: P. Dalgin; Stuart, Fla.: M. Ettinger; Tucson, Ariz.: M. Maricic; Trumbull, Conn.: S. Cohen; West Palm Beach, Fla.: M. Schweitz and R. Turner; Whittier, Calif.: R. Harris; and Wichita, Kans.: R. Lies.

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• Cockayne, S., Adamson, J., Lanham-New, S., Shearer, M. J., Gilbody, S., Torgerson, D. J. (2006). Vitamin K and the Prevention of Fractures: Systematic Review and Meta-analysis of Randomized Controlled Trials.. Arch Intern Med 166: 1256-1261 [Abstract] [Full Text]  
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• Nayak, S., Olkin, I., Liu, H., Grabe, M., Gould, M. K., Allen, I. E., Owens, D. K., Bravata, D. M. (2006). Meta-analysis: accuracy of quantitative ultrasound for identifying patients with osteoporosis.. ANN INTERN MED 144: 832-841 [Abstract] [Full Text]  
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• Karlsson, M. K., Gerdhem, P., Ahlborg, H. G. (2005). The prevention of osteoporotic fractures. J Bone Joint Surg Br 87-B: 1320-1327 [Full Text]  
• Cosman, F., Nieves, J., Zion, M., Woelfert, L., Luckey, M., Lindsay, R. (2005). Daily and Cyclic Parathyroid Hormone in Women Receiving Alendronate. NEJM 353: 566-575 [Abstract] [Full Text]  
• Rosen, C. J. (2005). Postmenopausal Osteoporosis. NEJM 353: 595-603 [Full Text]  
• Sato, Y., Kanoko, T., Satoh, K., Iwamoto, J. (2005). The Prevention of Hip Fracture With Risedronate and Ergocalciferol Plus Calcium Supplementation in Elderly Women With Alzheimer Disease: A Randomized Controlled Trial. Arch Intern Med 165: 1737-1742 [Abstract] [Full Text]  
• Sato, Y., Iwamoto, J., Kanoko, T., Satoh, K. (2005). Risedronate Sodium Therapy for Prevention of Hip Fracture in Men 65 Years or Older After Stroke. Arch Intern Med 165: 1743-1748 [Abstract] [Full Text]  
• McClung, M. R., San Martin, J., Miller, P. D., Civitelli, R., Bandeira, F., Omizo, M., Donley, D. W., Dalsky, G. P., Eriksen, E. F. (2005). Opposite Bone Remodeling Effects of Teriparatide and Alendronate in Increasing Bone Mass. Arch Intern Med 165: 1762-1768 [Abstract] [Full Text]  
• Hodsman, A. B., Bauer, D. C., Dempster, D. W., Dian, L., Hanley, D. A., Harris, S. T., Kendler, D. L., McClung, M. R., Miller, P. D., Olszynski, W. P., Orwoll, E., Yuen, C. K. (2005). Parathyroid Hormone and Teriparatide for the Treatment of Osteoporosis: A Review of the Evidence and Suggested Guidelines for Its Use. Endocr. Rev. 26: 688-703 [Abstract] [Full Text]  
• Fogelman, I., Blake, G. M (2005). Strontium ranelate for the treatment of osteoporosis. BMJ 330: 1400-1401 [Full Text]  
• Hosking, D.J., Geusens, P., Rizzoli, R. (2005). Osteoporosis therapy: an example of putting evidence-based medicine into clinical practice. QJM 98: 403-413 [Abstract] [Full Text]  
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• Reginster, J.-Y. (2005). Treatment of postmenopausal osteoporosis. BMJ 330: 859-860 [Full Text]  
• Licata, A. A (2005). Discovery, Clinical Development, and Therapeutic Uses of Bisphosphonates. The Annals of Pharmacotherapy 39: 668-677 [Abstract] [Full Text]  
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• Ott, S. M. (2005). Long-Term Safety of Bisphosphonates. J. Clin. Endocrinol. Metab. 90: 1897-1899 [Full Text]  
• Kern, L. M., Powe, N. R., Levine, M. A., Fitzpatrick, A. L., Harris, T. B., Robbins, J., Fried, L. P. (2005). Association between Screening for Osteoporosis and the Incidence of Hip Fracture. ANN INTERN MED 142: 173-181 [Abstract] [Full Text]  
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• Papapoulos, S. E. (2005). Long-Term Therapy of Osteoporosis with Bisphosphonates: Evidence and Implications for Daily Practice. IBMS BoneKEy 2: 13-19 [Full Text]  
• Gardner, M. J., Brophy, R. H., Demetrakopoulos, D., Koob, J., Hong, R., Rana, A., Lin, J. T., Lane, J. M. (2005). Interventions to Improve Osteoporosis Treatment Following Hip Fracture. A Prospective, Randomized Trial. JBJS 87: 3-7 [Abstract] [Full Text]  
• Dansereau, R. J, Crail, D. J (2005). Extemporaneous Procedures for Dissolving Risedronate Tablets for Oral Administration and for Feeding Tubes. The Annals of Pharmacotherapy 39: 63-67 [Abstract] [Full Text]  
• Bouxsein, M. L., Kaufman, J., Tosi, L., Cummings, S., Lane, J., Johnell, O. (2004). Recommendations for Optimal Care of the Fragility Fracture Patient to Reduce the Risk of Future Fracture. J Am Acad Orthop Surg 12: 385-395 [Abstract] [Full Text]  
• HEGEMAN, J. H., OSKAM, J., VAN DER PALEN, J., TEN DUIS, H. J., VIERHOUT, P. A. M. (2004). The Distal Radial Fracture in Elderly Women and the Bone Mineral Density of the Lumbar Spine and Hip. J Hand Surg Eur Vol 29: 473-476 [Abstract] [Full Text]  
• Lenchik, L., Rogers, L. F., Delmas, P. D., Genant, H. K. (2004). Diagnosis of Osteoporotic Vertebral Fractures: Importance of Recognition and Description by Radiologists. Am. J. Roentgenol. 183: 949-958 [Full Text]  
• Jin, H., Lu, Y., Harris, S. T., Black, D. M., Stone, K., Hochberg, M. C., Genant, H. K. (2004). Classification Algorithms for Hip Fracture Prediction Based on Recursive Partitioning Methods. Med Decis Making 24: 386-398 [Abstract]  
• Bjarnason, N. H., Chan, A. S., Ott, S. M., Ruggiero, S. L., Mehrotra, B., Bone, H. G., Santora, A. C. (2004). Ten Years of Alendronate Treatment for Osteoporosis in Postmenopausal Women. NEJM 351: 190-192 [Full Text]  
• Torgerson, D J, Sykes, D, Puffer, S, Brown, P, Cooper, C (2004). Pharmaceutical treatment of symptomatic vertebral fractures in primary care. Ann Rheum Dis 63: 853-856 [Abstract] [Full Text]  
• Siris, E. S., Chen, Y.-T., Abbott, T. A., Barrett-Connor, E., Miller, P. D., Wehren, L. E., Berger, M. L. (2004). Bone Mineral Density Thresholds for Pharmacological Intervention to Prevent Fractures. Arch Intern Med 164: 1108-1112 [Abstract] [Full Text]  
• Francis, R.M., Baillie, S.P., Chuck, A.J., Crook, P.R., Dunn, N., Fordham, J.N., Kelly, C., Rodgers, A. (2004). Acute and long-term management of patients with vertebral fractures. QJM 97: 63-74 [Abstract] [Full Text]  
• Dolan, A L, Koshy, E, Waker, M, Goble, C M (2004). Access to bone densitometry increases general practitioners' prescribing for osteoporosis in steroid treated patients. Ann Rheum Dis 63: 183-186 [Abstract] [Full Text]  
• Brown, S. A., Sharpless, J. L. (2004). Osteoporosis: An Under-appreciated Complication of Diabetes. Clin. Diabetes 22: 10-20 [Abstract] [Full Text]  
• Grados, F., Brazier, M., Kamel, S., Mathieu, M., Hurtebize, N., Maamer, M., Garabedian, M., Sebert, J.-L., Fardellone, P. (2003). Prediction of Bone Mass Density Variation by Bone Remodeling Markers in Postmenopausal Women with Vitamin D Insufficiency Treated with Calcium and Vitamin D Supplementation. J. Clin. Endocrinol. Metab. 88: 5175-5179 [Abstract] [Full Text]  
• Ettinger, M. P. (2003). Aging Bone and Osteoporosis: Strategies for Preventing Fractures in the Elderly. Arch Intern Med 163: 2237-2246 [Abstract] [Full Text]  
• Cauley, J. A., Robbins, J., Chen, Z., Cummings, S. R., Jackson, R. D., LaCroix, A. Z., LeBoff, M., Lewis, C. E., McGowan, J., Neuner, J., Pettinger, M., Stefanick, M. L., Wactawski-Wende, J., Watts, N. B. (2003). Effects of Estrogen Plus Progestin on Risk of Fracture and Bone Mineral Density: The Women's Health Initiative Randomized Trial. JAMA 290: 1729-1738 [Abstract] [Full Text]  
• Murphy, F. T., Kivitz, A. J., Sands, E. E. (2003). Management of Postmenopausal Osteoporosis. JAOA: Journal of the American Osteopathic Association 103: S6-S11 [Abstract] [Full Text]