El alendronato frente al raloxifene en mujeres menopáusicas. (Inglés)

El alendronato produce mejores efectos que el raloxifene en la densidad y movilidad ósea en mujeres postmenopáusicas con baja densidad ósea: Resultados del efecto (la eficacia de FOSAMAX contra EVISTA, el ensayo de la comparación) Internacional 1.

Abstract

Objectives
Alendronate and raloxifene are antiresorptive agents with different mechanisms of action, each used to treat osteoporosis in postmenopausal women. This study was undertaken to compare the efficacy and tolerability of alendronate to raloxifene in postmenopausal women with low-bone density.

Design
Randomized, double-masked, double-dummy multicentre international study.

Setting
Clinical trial centres in Europe, South America and Asia-Pacific.

Subjects
A total of 487 postmenopausal women with low bone density, based on bone mineral density (BMD) of the lumbar spine or hip (T-score <=-2.0).

Interventions
Patients received either alendronate 70 mg once weekly and daily placebo identical to raloxifene or raloxifene 60 mg daily and weekly placebo identical to alendronate for 12 months.

Main outcome measures
Evaluations included BMD of the lumbar spine and hip and markers of bone turnover at 6 and 12 months and adverse event reporting.

Results
Alendronate demonstrated substantially greater increases in BMD than raloxifene at both lumbar spine and hip sites at 12 months. Lumbar spine BMD increased 4.8% with alendronate vs. 2.2% with raloxifene (P < 0.001). The increase in total hip BMD was 2.3% with alendronate vs. 0.8% with raloxifene (P < 0.001). Reductions in bone turnover were significantly larger with alendronate than raloxifene. Overall tolerability was similar, however, the proportion of patients reporting vasomotor events was significantly higher with raloxifene (9.5%) than with alendronate (3.7%, P = 0.010). The proportion of patients reporting gastrointestinal events was similar between groups.

Conclusion
In postmenopausal women with low bone density, improvements in BMD and markers of bone turnover were substantially greater during treatment with alendronate compared to raloxifene.

Journal of Internal Medicine. Volume 255: Issue 4