Effective Pharmacotherapeutic Interventions for the Prevention of Hip Fractures

Abstract

The hip is the most common nonvertebral fracture site in patients with osteoporosis. Because the incidence of hip fracture is expected to increase dramatically as the population ages and osteoporosis becomes more common, interventions that prevent hip fracture and reduce or prevent osteoporosis are important therapeutic steps. A number of prospective, clinical trials have been conducted that evaluated the antifracture efficacy of various drugs and supplements. These include calcium, vitamin D, calcitonin, raloxifene, hormone replacement therapy, and bisphosphonates. A review of these trials leads to the conclusion that a combination regimen of a bisphosphonate with calcium and vitamin D provides the most effective protection against hip fracture. Both risedronate and alendronate have demonstrated efficacy in reducing the incidence of hip fracture. The effectiveness of risedronate was demonstrated in a clinical trial in which hip fracture was the primary efficacy endpoint. For alendronate, a subgroup analysis of a secondary endpoint and a meta-analysis provided evidence of a reduction in hip fracture incidence. In clinical trials, treatment with risedronate plus calcium and vitamin D has demonstrated usefulness in reducing the incidence of nonvertebral fractures.