Bone turnover matters: the raloxifene treatment paradox of dramatic decreases in vertebral fractures without commensurate increases in bone density.

Abstract

The summum bonum of osteoporosis treatment is the prevention of new fractures. In vitro studies have shown that 60 ‐ 80% of the compressive strength of bone is caused by its mineral content. (1) Correspondingly, observational studies show that baseline bone mineral density (BMD) measurements at multiple skeletal sites can predict various types of osteoporotic fractures in postmenopausal women. (2) In general, a decrease in BMD of 1.0 SD increases the risk of future fractures by ;2.0-fold. The observational data from epidemiological studies have been confirmed by results of randomized clinical trials (RCTs) showing that antiresorptive agents both increase BMD and decrease vertebral frac