Severely suppressed bone turnover: A potential complication of alendronate therapy

Clarita V. Odvina, Joseph E. Zerwekh, D. Sudhaker Rao, Naim Maalouf, Frank A. Gottschalk, Charles Y C Pak

Research output: Contribution to journalArticle

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Abstract

Alendronate, an inhibitor of bone resorption, is widely used in osteoporosis treatment. However, concerns have been raised about potential oversuppression of bone turnover during long-term use. We report on nine patients who sustained spontaneous nonspinal fractures while on alendronate therapy, six of whom displayed either delayed or absent fracture healing for 3 months to 2 yr during therapy. Histomorphometric analysis of the cancellous bone showed markedly suppressed bone formation, with reduced or absent osteoblastic surface in most patients. Osteoclastic surface was low or low-normal in eight patients, and eroded surface was decreased in four. Matrix synthesis was markedly diminished, with absence of double-tetracycline label and absent or reduced single-tetracycline label in all patients. The same trend was seen in the intracortical and endocortical surfaces. Our findings raise the possibility that severe suppression of bone turnover may develop during long-term alendronate therapy, resulting in increased susceptibility to, and delayed healing of, nonspinal fractures. Although coadministration of estrogen or glucocorticoids appears to be a predisposing factor, this apparent complication can also occur with monotherapy. Our observations emphasize the need for increased awareness and monitoring for the potential development of excessive suppression of bone turnover during long-term alendronate therapy.

Original languageEnglish (US)
Pages (from-to)1294-1301
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume90
Issue number3
DOIs
StatePublished - Mar 2005

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Alendronate
Bone Remodeling
Bone
Fracture Healing
Tetracycline
Labels
Bone Density Conservation Agents
Therapeutics
Spontaneous Fractures
Osteogenesis
Causality
Glucocorticoids
Osteoporosis
Estrogens
Monitoring

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology, Diabetes and Metabolism

Cite this

Severely suppressed bone turnover : A potential complication of alendronate therapy. / Odvina, Clarita V.; Zerwekh, Joseph E.; Rao, D. Sudhaker; Maalouf, Naim; Gottschalk, Frank A.; Pak, Charles Y C.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 90, No. 3, 03.2005, p. 1294-1301.

Research output: Contribution to journalArticle

Odvina, Clarita V. ; Zerwekh, Joseph E. ; Rao, D. Sudhaker ; Maalouf, Naim ; Gottschalk, Frank A. ; Pak, Charles Y C. / Severely suppressed bone turnover : A potential complication of alendronate therapy. In: Journal of Clinical Endocrinology and Metabolism. 2005 ; Vol. 90, No. 3. pp. 1294-1301.
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