N Engl J Med

Zoledronate for fracture risk reduction: How far can the dosing interval be extended?

January 17, 2025

Infrequent zoledronate administration (every 5 years) is effective in reducing vertebral fracture risk in early postmenopausal women, offering a viable preventive strategy for those at low to intermediate fracture risk.

Study Design: This 10-year, prospective, double-blind, randomized controlled trial involved 1,054 early postmenopausal women ages 50 to 60 years with bone mineral density T scores between 0 and -2.5. Participants were randomly assigned to receive zoledronate 5 mg at baseline and at 5 years (zoledronate–zoledronate group), zoledronate 5 mg at baseline and placebo at 5 years (zoledronate–placebo group), or placebo at both time points (placebo–placebo group). The primary endpoint was the incidence of morphometric vertebral fractures.

Results: At 10 years, the zoledronate–zoledronate group had a significantly lower incidence of new morphometric vertebral fractures (6.3%) compared with the placebo–placebo group (11.1%) (relative risk [RR], 0.56; P = 0.04). The zoledronate–placebo group also showed a reduced fracture risk (6.6%) compared with placebo (RR, 0.59; P = 0.08). Secondary outcomes, including fragility fractures and major osteoporotic fractures, were also reduced in the zoledronate groups.

Source:

Bolland MJ, et al. (2025, January 16). N Engl J Med. Fracture Prevention with Infrequent Zoledronate in Women 50 to 60 Years of Age. https://pubmed.ncbi.nlm.nih.gov/39813642/