The Findings of Bone Mineral Densitometry Following Preventive Treatment with Alendronate in Menopausal Women with Osteopenia; What is the Best Dose?

Osteoporosis is the most common metabolic bone disease worldwide that is defined by lessened bone density. Osteoporosis progression is accompanied with increased risk of pathologic fractures. Osteopenia is attributed to the first steps of bone density loss process. Studies about treatment initiation while osteopenia is presented, and the treatment dose, are controversial. In this study, low dose versus high dose of alendronate among menopausal women with osteopenia was evaluated.

The current randomized clinical trial (RCT) study was conducted on 152 menopausal women with osteopenia referred to a rheumatology clinic during 2017-18. Patients were randomly divided into two groups of treatment with weekly doses of 35 mg and 70 mg alendronate, and then followed for two years. Bone mineral densitometry (BMD) was performed for all the patients prior to and after treatment, and findings were compared.

Two assessed groups were not statistically different regarding age, gender, height, weight, and body mass index (BMD) (P > 0.050 for all). BMD findings of two groups including hip and spine/wrist Fracture risk assessment system (FRAX), hip and spine T-score, and hip and spine Z-score significantly improved following two years (P < 0.001); but the comparison of two doses presented no statistical difference considering BMD findings improvement (P > 0.050).

Findings of this study are in favor of preventive treatment with alendronate in women with osteopenia. Furthermore, considering digestive irritability as the main complaint of alendronate, based on our findings, weekly 35 mg use of this agent can be considered.