Alendronate For Osteoporosis Research Articles

Low-level laser therapy as an adjuvant in the treatment of erythema multiforme of the oral mucosa: a case report

Erythema multiforme is an autoimmune condition that can affect the skin and mucosa. Oral lesions initially present with edema and progress to superficial erosions with pseudomembrane formation. The most recommended treatment is the use of corticosteroids; however, low-level laser therapy can be effective in the treatment of erythema multiforme. We report a case of erythema multiforme in the oral mucosa treated with low-level laser therapy. A 73-year-old woman using alendronate for osteoporosis, losartan, and puran T4 with extensive ulcers on the upper and lower lips. The clinical diagnosis was erythema multiforme. The proposed treatment was 0.05% clobetasol propionate in gel, 3 times a day, and seven sessions of low-level laser therapy on alternate days. Low-level laser therapy significantly improved the erythema multiforme of the oral mucosa, offering the patient a non-invasive approach with no side effects.

Scoping Review of Randomized Trials With Discontinuation of Medicines in Older Adults.

To map the randomized trial evidence describing the feasibility of discontinuing active medications with potential adverse effects in older patients. Scoping review with systematic search of PubMed, Embase, and Cochrane Library. Randomized trials investigating discontinuation of a single medicine or medicine class in patients with mean age ≥65years. We extracted trial characteristics including study design and assessed bias. As proxies for the "feasibility of discontinuation," we extracted the "dropout rate" and "disease recurrence rate." We identified 40 trials investigating discontinuation of symptomatic (n= 26), preventive (n= 6), or both preventive and symptomatic medicines (n= 8) against psychiatric (n= 10), neurologic (n= 9), musculoskeletal (n= 8), cardiovascular (n= 5), respiratory (n= 4), and urologic diseases (n= 4). Five discontinuation designs were used, 75% (30/40) of trials were placebo-controlled, and 48% (19/40) of trials had bias disfavoring discontinuation. The dropout rate was similar between the discontinuation group and the continuation group in 79% of the trials (30/38), whereas disease recurrence was similar in 72% (23/32) of the trials. In 42% (13/31) of trials reporting both dropout rate and disease recurrence rate, the differences between groups were statistically insignificant and less than 10%; these trials investigated discontinuation of cholinesterase inhibitors for Alzheimer's disease in various settings (n= 3), alendronate for osteoporosis (n= 3), glucosamine for osteoarthritis, lithium as adjunct for unipolar depression, statins for cardiovascular disease in patients with limited life expectancy, droxidopa for neurogenic orthostatic hypotension, tamsulosin for lower urinary tract symptoms, sertraline for major depressive episode, and fentanyl patch for low back or osteoarthritis pain. We identified 40 randomized trials using a variety of designs investigating discontinuation of both symptomatic and preventive medicines in older patients. Discontinuation of medicines seems feasible for most of the investigated medicines. This scoping review can guide clinical practice and future trials on deprescribing.

Antimicrobial photodynamic and photobiomodulation adjuvant therapies for medication-related osteonecrosis of the jaw – Report of two cases with long-term follow-up

Medication-related osteonecrosis of the jaw (MRONJ) is a relatively rare condition with high morbidity. In this study, we report the management of two recalcitrant cases of MRONJ in the mandibles of two older women who received treatment with alendronate for osteoporosis. Sequestrectomies, combined with antimicrobial photodynamic therapy (aPDT) and photobiomodulation (PBMT), were performed in both patients. During perioperative and weekly postoperative aPDT sessions, a diode laser treated three anatomical points by emitting a continuous gallium-aluminum-arsenide wave at 660 nm (red laser), 0.028 cm2, 0.1 W, 3.57 W/cm2 for 90 s per point, 9 J per point, 321 J/cm2, and a total energy of 27 J. PBMT was applied weekly after surgery at 808 nm wavelength (other parameters being equal) for wound healing and pain relief. Both patients were followed-up for two years without any report of recurrence. Thus, aPDT and PBMT can be considered non-invasive adjuvant therapies for MRONJ without any adverse effects.

Use of a generic violet light in the surgical management of medication-related osteonecrosis of the jaws: a technical note

Fluorescence-guided surgery has been recommended for the diagnosis of bone margins in cases of mandibular osteonecrosis. In this article, we report a case in which a generic violet light was used in order to activate bone fluorescence after the administration of tetracycline derivatives, as an alternative to a specific, more expensive equipment that is commercially available for this purpose. The patient had been using alendronate for osteoporosis, resulting in medication-related osteonecrosis of the jaws. The treatment protocol includes preoperative administration of doxycycline and the application of a generic violet light during surgery in order to observe the fluorescence of bone in response to excitation through the light emitted by this device. With an effective visualization of the limit between healthy and devitalized bone tissue, it was possible to perform the necrotic tissue removal. The lesion regressed from stage 2 to stage 0, with no clinical or radiographic evidence of necrotic bone. These results suggest the feasibility of using a generic violet light source as a low-cost alternative for fluorescence-guided surgery.

Surgically treated osteonecrosis and osteomyelitis of the jaw and oral cavity in patients highly adherent to alendronate treatment: a nationwide user-only cohort study including over 60,000 alendronate users.

ONJ is a rare event in users of oral bisphosphonates. Our aims were to evaluate if the risk of surgically treated ONJ increases with longer or more compliant treatment with alendronate for osteoporosis and to identify risk factors for surgically treated ONJ. Open nationwide register-based cohort study containing one nested case-control study. Patients were treatment-naïve incident users of alendronate 1996-2007 in Denmark, both genders, aged 50-94 at the time of beginning treatment (N=61,990). Participants were followed to 31 December 2013. Over a mean of 6.8years, 107 patients received surgery for ONJ or related conditions corresponding to an incidence rate of 2.53 (95% confidence interval (CI) 2.08 to 3.05) per 10,000 patient years. Recent use was associated with an adjusted odds ratio (OR) 4.13 (95% CI 1.94 to 8.79) compared to past use. Similarly, adherent users (medication possession ratio (MPR) >50%) were at two to threefold increased risk of ONJ compared to low adherence (MPR <50%), and long-term (>5years) use was related with higher risk (adjusted OR 2.31 (95% CI (1.14 to 4.67)) than shorter-term use. History of rheumatoid disorders and use of proton pump inhibitors were independently associated with surgically treated ONJ. Our data suggest that recent, long-term, and compliant uses of alendronate are associated with an increased risk of surgically treated ONJ. Nevertheless, the rates remain low, even in long-term adherent users. ONJ risk appears higher in patients with conditions likely to indirectly affect the oral mucosa.

Atypical Fracture of the Sternum After Long-Term Alendronate Plus Cholecalciferol Treatment: A Case Report.

A 55-year-old woman developed an atraumatic sternum fracture during treatment with alendronate for osteoporosis. The woman received alendronate 70 mg in combination with cholecalciferol 5600 IU once weekly, as well as nonsteroidal anti-inflammatory drugs. After 4 years of treatment, following a dorsal flexion with no direct thoracic trauma, the patient suffered a fracture of the sternum, with an X-ray revealing sternal body fracture. This fracture was seen to be transverse, noncomminuted and without displacement. Magnetic resonance imaging was carried out to rule out the presence of either a pathological fracture or a fracture resulting from osteoporotic fragility, and showed a triple sternal fracture involving the body, as well as the upper and lower manubrium of the sternum. This fracture presented the features of an atypical femur fracture, except for the location. The alendronate and cholecalciferol combination was discontinued and denosumab was prescribed. After the withdrawal of alendronate, the patient showed clinical improvement, with a decrease in pain, and is currently having routine checkups. The causality algorithm of the Spanish Pharmacovigilance System shows a score of 5, indicating a possible relationship between the patient’s sternum fracture and her use of the suspect drug (Naranjo scale 6 = probable).

Parathyroid Hormone Plus Alendronate in Osteoporosis: A Meta-Analysis of Randomized Controlled Trials

ABSTRACTBackground: Parathyroid hormone (PTH) increases both bone formation (BMD) and bone resorption, whereas alendronate reduces bone resorption. It is possible that the combination therapy will enhance their effects on BMD. Therefore, we conducted this meta-analysis to evaluate the efficacy of the combination therapy in osteoporosis. Methods: A comprehensive literature search of Pubmed, Embase, and Web of Science was conducted to identify relative studies. The outcomes included the mean percent increases in BMD of lumbar spine, femoral neck, total hip, and distal radius. A fixed-effects model or random-effects was used to pool the estimates according to the heterogeneity. Results: Six RCTs with a total number of 833 patients were included in this meta-analysis. The pooled estimates showed that, the combination therapy resulted in a higher mean percent change of increased BMD in distal radius (WMD = 2.45, 95%CI: 1.58, 3.31; 0.000), but not in lumbar spine (WMD = −0.83, 95%CI: −3.48, 1.81; p = .538), femoral neck (WMD = −0.99, 95%CI: −2.04, 0.07; p = .068), and total hip (WMD = −0.06, 95%CI: −0.93, 0.81; p = .892). Subgroup analysis revealed that among the patients in the combination therapy group, greater increases in the spine BMD were observed when the PTH was administered with a dosage of 20 μg (WMD = 2.33, 95%CI: 1.24, 3.43; p = .000), or the treatment duration lasted more than 12 months (WMD = 2.23, 95%CI: 1.00, 3.47; p = .000), or the combination therapy was used in osteoporosis women (WMD = 1.58, 95%CI: 0.63, 2.53; p = .001). Conclusion: Our findings indicated that combination therapy in the treatment of osteoporosis, reduced the ability of PTH therapy to increase the BMD at the lumbar spine, femoral neck, and total hip.

Randomized trial comparing monthly ibandronate and weekly alendronate for osteoporosis in patients with primary biliary cirrhosis

Osteoporosis resulting in bone fractures is a complication in patients with primary biliary cirrhosis (PBC). Once-weekly alendronate improves bone mass and is well tolerated in these patients, but there is a concern because of poor compliance. Therefore, the efficacy, adherence, and safety of monthly ibandronate (150 mg) with weekly alendronate (70 mg) were compared in a randomized, 2-year study in 42 postmenopausal women with PBC and osteoporosis. Bone mineral density (BMD) of the lumbar spine and proximal femur (by DXA), liver function, and bone markers were measured at entry and every 6 months over 2 years. Adherence to therapy was assessed by the Morisky-Green score. At enrollment, the two groups were similar with respect to age, BMD, severity of cholestasis, previous fractures, and bone markers. Thirty-three patients, 14 in the ibandronate group and 19 in the alendronate group, completed the trial. At 2 years both treatments resulted in a significant increase in BMD at the lumbar spine (from 0.875 ± 0.025 to 0.913 ± 0.026 g/cm(2), P < 0.001 with alendronate, and from 0.898 ± 0.024 to 0.949 ± 0.027 g/cm(2), P < 0.001 with ibandronate). The mean percentage change was 4.5% and 5.7%, respectively (P = not significant). BMD increased at the total hip by 2.0% and 1.2%, respectively. Changes in bone markers were similar in both groups and one patient with alendronate developed a new vertebral fracture. Adherence to therapy was higher with ibandronate (P = 0.009). Neither treatment impaired liver function or cholestasis. Both regimens, weekly alendronate and monthly ibandronate, improve bone mass and are comparable in safety for osteoporosis therapy in patients with PBC, although adherence is higher with the monthly regimen. Further larger studies are needed to assess fracture prevention.

Bisphosphonate-associated osteonecrosis of the external auditory canal

Osteonecrosis is a benign condition characterised by necrotic exposed bone, and is associated with bisphosphonate use. Osteonecrosis of the external auditory canal is rare, with only a few reported cases. Two case reports of temporal bone osteonecrosis are presented. A 64-year-old man with a history of immunoglobulin G kappa multiple myeloma developed a right external auditory canal ulcer 6 years after commencement on clodronate. A 72-year-old woman taking alendronate for osteoporosis, initially diagnosed and treated for right-sided otitis externa, was found to have underlying exposed bone in the right external auditory canal, with a computed tomography scan confirming destruction of the temporal bone. With increasing use of both oral and intravenous bisphosphonates in the community for benign conditions such as osteoporosis and for malignant conditions such as breast cancer and multiple myeloma, the diagnosis of bisphosphonate-associated osteonecrosis should always be considered in patients with a temporal bone lesion, and a relevant drug history taken.

A Lesson from the Failure of Intramedullary Fixation of Atypical Subtrochanteric Fractures: A Report of Two Cases.

Surgical fixation of subtrochanteric fractures remains technically challenging, even to experienced fracture surgeons. These fractures are often treated with intramedullary devices; fixed-angle plating is an alternative. Recently, there have been an increasing number of reports about bisphosphonate-related atypical femoral fractures occurring at the subtrochanteric or proximal diaphyseal region1-4. These fractures are characterized by cortical beaking, thickening of the femoral cortex prior to fractures, and transverse or short oblique orientation in people who have been on long-term bisphosphonate therapy2,3,5,6. As with the vast majority of trauma-related subtrochanteric fractures, these bisphosphonate-related fractures are usually stabilized with cephalomedullary devices. Surgeons often do not pay adequate attention to the length of the intramedullary nail, which in effect is the working length of the fixation. Short nails are sometimes used for ease of insertion and their availability in most operating rooms. Spanning the distal femoral region with a longer nail is erroneously viewed as unnecessary. In fact, the less biomechanically sound fixation achieved by a short nail will predispose to the occurrence of delayed union, nonunion, and implant breakage. We report two cases of atypical subtrochanteric fractures in patients who had been on long-term bisphosphonate therapy; treatment with short cephalomedullary nails failed in both. We also discuss the underlying failure mechanism. Both patients were informed that data concerning their cases would be submitted for publication, and they provided consent. Case 1. An eighty-two-year-old woman who had taken alendronate for osteoporosis for six years was admitted to the hospital after a …

Atypical Femoral Fractures Shortly After Osteonecrosis of the Jaw in a Postmenopausal Woman Taking Alendronate for Osteoporosis

Bisphosphonates effectively increase bone mineral density and reduce fracture risk in patients with osteoporosis, but there are concerns about osteonecrosis of the jaw (ONJ) and atypical femoral fractures (AFFs) in the long-term users. So far both complications have not been reported as occurring simultaneously in an osteoporotic individual on oral alendronate. The aim of this study was to report a postmenopausal woman presenting with concomitant ONJ and AFF on oral alendronate treatment. SUBJECT, MEASURES, AND RESULT: The patient was a 63-year-old woman with a history of rheumatoid arthritis for 30 years and diabetes for 3 years. Spinal compression fractures at levels L3 and L4 were documented, and she took alendronate 70 mg weekly for 7 years. She is the first case whose dental periapical imaging and pelvic radiography documented her ONJ and AFF, which developed subsequently within 6 months. This case report supports the association of both ONJ and AFF with long-term oral bisphosphonate therapy.

A multicenter randomized double-masked comparative study of different preparations of alendronate in osteoporosis – monthly (four weeks) intravenous versus once weekly oral administrations

Objective:The aim of this study was to evaluate the efficacy and safety of intravenous alendronate (ALN) 900 µg every 4 weeks compared to oral ALN 35 mg once weekly.Methods:A 52-week, multicenter, randomized, double-masked, active-controlled, parallel-group, non-inferiority study was conducted in a total of 325 Japanese patients aged 48–87 years with osteoporosis. Patients were randomly assigned to an intravenous ALN (iv, n = 162) group or oral ALN (po, n = 163) group. The efficacy of the both formulations was assessed primarily by bone mineral density (BMD) measurement.Results:The percentage BMD change from baseline in lumbar spine (L2–L4) after 52 weeks of treatment was 6.4 ± 0.3% in the iv group and 6.0 ± 0.3% in the po group (least-squares mean ± SE). The inter-group difference in least-squares mean of percentage change from baseline in BMD was 0.37%, and its 95% confidence interval was −0.47% to 1.20%. The non-inferiority of the iv group was established against the po group with a prespecified non-inferiority margin (Δ) of 1.5%. In addition, the four bone turnover markers were reduced to a similar level by either treatment throughout the treatment period. The safety profile was also similar between the two treatment groups. Because of the limitations presented in this study, the results of the iv group may not apply to non-Japanese patients with osteoporosis.Conclusions:The efficacy and safety of the intravenous ALN 900 µg once every 4 weeks were similar to those of the oral ALN 35 mg once weekly, indicating that intravenous administration of ALN is an effective treatment for osteoporosis and will provide a useful alternative to oral dosing.

How Long to Take Alendronate for Osteoporosis

Alendronate has been shown to increase bone mineral density (BMD) and decrease fracture risk in postmenopausal women with osteoporosis, but the need

Elevations in Serum and Urinary Calcium with Parathyroid Hormone (1-84) with and without Alendronate for Osteoporosis

The effect of PTH therapy on serum and urinary calcium levels and the risk of hypercalcemia or hypercalciuria has not been formally evaluated. The objective was to examine changes in serum and urinary calcium associated with PTH(1-84) therapy in the PaTH trial and the extent to which a defined algorithm resolved the elevated values. A total of 178 postmenopausal women were randomized to PTH(1-84) either alone or in combination with alendronate during the first year of the PaTH study. The main outcome measures were fasting serum calcium at baseline and 1, 3, and 12 months and 24-h urinary calcium at baseline and 3 months. In 14% of participants, serum calcium more than 10.5 mg/dl (>2.6 mmol/liter) developed. Following the defined algorithm, 58% of elevated measurements were normal on repeat testing; 38% required discontinuation of calcium and vitamin D supplementation, and one necessitated a decrease in PTH injection frequency to normalize serum calcium. One participant developed transient hypercalcemia between study visits and required hospitalization; the episode resolved with iv hydration and PTH discontinuation. Baseline characteristics associated with the development of hypercalcemia were serum calcium [relative hazards = 1.9 per 0.5 mg/dl (0.12 mmol/liter); 95% confidence interval = 1.1-3.2] and serum 1,25-dihydroxyvitamin D [relative hazard = 1.9 per 10 pg/ml (26 pmol/liter); 95% confidence interval = 1.2-3.1]. Fifteen women (8%) developed hypercalciuria [urinary calcium > 400 mg (100 mmol)/24 h or calcium/creatinine ratio > 0.4]; 80% of cases resolved after discontinuing calcium and vitamin D, 13% without intervention, and one after PTH injection frequency was decreased. Higher baseline urinary calcium excretion was associated with development of hypercalciuria [relative hazard = 1.5 per 50 mg/d (12.5 mmol/d); 95% confidence interval = 1.2-4.0]. Proportions of patients with elevated serum and urinary calcium were similar on single and combination therapy. The frequency of episodic hypercalcemia or hypercalciuria in the PaTH trial was 21%. Episodes were generally mild, and nearly all cases resolved spontaneously or with discontinuation of calcium and vitamin D. The algorithms used to address hypercalcemia and hypercalciuria in the PaTH trial proved effective in safely resolving clinical episodes of increased urinary or serum calcium and might therefore be helpful to clinicians caring for patients on PTH.

Bisphosphonate‐associated osteonecrosis of mandibular and maxillary bone

AbstractBACKGROUNDThe current report presented 17 patients with cancer with bone metastases and 1 patient with osteopenia who received treatment with bisphosphonates and who subsequently developed osteonecrosis of the mandible and/or maxilla.METHODSThe authors reviewed information on 18 patients who were referred to oral medicine or oral surgery specialists for evaluation and treatment of mandibular and/or maxillary bone necrosis from June 2002 to September 2004. To be included in the current review, patients must have been treated with either pamidronate or zoledronic acid to control or prevent metastatic disease, or with alendronate for osteoporosis. All patients with cancer had received chemotherapy while receiving bisphosphonate management.RESULTSThe 17 patients with cancer were receiving active medical care for a malignancy. Cancer treatment included a variety of chemotherapeutic agents. They presented with metastatic disease to bone and were treated intravenously with the bisphosphonates pamidronate or zoledronic acid for a mean time of 25 months (range, 4–41 mos). There were 14 females and 4 males with a mean age of 62 years (range, 37–74 yrs). Malignancies included breast carcinoma (n = 10), multiple myeloma (n = 3), prostate carcinoma (n = 1), ovarian carcinoma (n = 1), prostate carcinoma/lymphoma (n = 1), and breast/ovarian carcinoma (n = 1). One female patient with osteopenia received alendronate. The most common clinical osteonecrosis presentations included infection and necrotic bone in the mandible. Associated events included dental extractions, infection, and trauma. Two patients appeared to develop disease spontaneously, without any clinical or radiographic evidence of local pathology. Despite surgical intervention, antibiotic therapy, hyperbaric oxygen therapy, and topical use of chemotherapeutic mouth rinses, most of the lesions did not respond well to therapy. Discontinuation of bisphosphonate therapy did not assure healing. However, 1 patient with cancer healed after discontinuation of bisphosphonate therapy for 4 months.CONCLUSIONSThe findings in the patient population combined with recent literature reports suggested that bisphosphonates may contribute to the pathogenesis of the oral lesions. The risk factors and precise mechanism involved in the formation of the osteonecrosis are not known. This condition represents a new oral complication in patients with cancer and can be termed bisphosphonate‐associated osteonecrosis. Lesions in patients with osteoporosis are worrisome and need to be further evaluated. Cancer 2005. © 2005 American Cancer Society.

Alendronate for osteoporosis in men with androgen-repleted hypogonadism

Male hypogonadism is associated with low bone mineral density (BMD) and an increased risk of fractures. Testosterone replacement therapy improves BMD in young hypogonadal men. This effect is milder in older patients, who are at greater risk for fractures. We studied the effects of alendronate or placebo on BMD in 22 osteoporotic men, 29-69 years of age (mean, 50.2+/-11.2 years) with long-standing hypogonadism, receiving standard testosterone replacement treatment. Alendronate 10 mg daily (n=11) increased lumbar-spine BMD by 6.0 and 8.4% at 6 and 12 months, respectively, compared with -0.5% at 6 months and +3.3% at 12 months in the placebo group (n=11; P<0.005). Alendronate also increased mean femoral-neck BMD by 1.9% after 1 year, compared to a 1.4% decrease with placebo (P<0.005), and increased the total body bone mineral content by 4.4%, compared to a 0.6% decrease with placebo (P=0.07). After 6 months alendronate suppressed urinary deoxypyridinoline by 50% (P<0.005), compared to a 24% decrease in the placebo group. Both the alendronate and placebo groups continued with alendronate 70 mg once weekly for the following 2 years. Lumbar-spine BMD during this open-label study phase did not change significantly in the group originally treated with alendronate, but continued to increase in the placebo-alendronate group by 5.4, 6.5, and 6.2% after 18 (6 months of alendronate), 24 and 36 months, respectively (P<0.05). Femoral-neck BMD continued to increase in both groups receiving active therapy; in the alendronate-alendronate group by 3.7, 2.7, and 5.2% after 18, 24, and 36 months, respectively (P=0.01), and in the placebo-alendronate group by 0.7 and 1.9% at 24 (first 12 months of alendronate) and 36 months, respectively (P<0.05). Our results support the long-term administration of alendronate along with testosterone replacement to men with hypogonadism-induced osteoporosis.

Assessment of bone metabolic markers after treatment with alendronate in osteoporosis

Assessment of bone metabolic markers after treatment with alendronate in osteoporosis

Ten Years’ Experience With Alendronate for Osteoporosis in Postmenopausal Women

This multinational randomized double-blind trial, the Alendronate Phase III Osteoporosis Treatment Study, examined the results of alendronate therapy in postmenopausal women with osteoporosis who now have been followed for 10 years. A total of 227 women completed all phases of the study. Those participating were assigned to receive 5 or 10 mg of alendronate orally or placebo each day. The primary end point was the change in bone mineral density (BMD) in the lumbar spine. BMD also was measured at the femoral neck, trochanter, total proximal femur, forearm region, and the total body. From 17% to 31% of women in the various treatment groups had preexisting vertebral fractures. BMD continued to increase in the later years of the study in women given 5 or 10 mg of alendronate daily. The mean cumulative increase after 10 years in women taking 10 mg daily was 13.7%. Markers of bone remodeling (urinary N-telopeptides of type I collagen, bone-specific alkaline phosphatase) decreased, and this effect continued through 10 years of treatment. These markers increased within a year after alendronate was discontinued, although mean levels remained below baseline. There were no significant group differences in new vertebral fractures. The 3 groups also had similar safety profiles in the last 3 years of the study. No deaths were ascribed to alendronate therapy. Alendronate therapy continued to be effective over 10 years in these postmenopausal women, as estimated by both BMD measurements and effects on bone remodeling. The antifracture effect of alendronate did not appear to decrease over time.

Ten years’ experience with alendronate for osteoporosis in postmenopausal women*

Ten years’ experience with alendronate for osteoporosis in postmenopausal women*

Progression of Coronary Artery Calcification in Patients Taking Alendronate for Osteoporosis

Rationale and Objectives As with their actions on bone, bisphosphonates may play a role in coronary artery calcification (CAC) by inhibiting calcium resorption from plaque. The objective of this study was to determine whether the osteoporosis treatment agent alendronate accelerates the rate of CAC. Materials and Methods The study was a pilot comparative analysis of 56 alendronate-treated patients with osteoporosis compared with 56 control subjects matched for age, sex, risk factors, and CAC scores and with a reference cohort that included 213 control subjects. Patients received alendronate sodium (10 mg daily) for a mean of 24 months and underwent annual assessment of CAC with electron-beam computed tomography and bone mineral density with dual x-ray absorptiometry. The principal outcome measure was the rate of change in CAC score in patients and control populations. Results There was significant progression of CAC in both alendronate-treated and matched-control groups (paired t test, P = .004 and .006, respectively) but no difference in the rates of CAC progression between the alendronate-treated patients and either the matched or reference control cohort. Conclusions This small pilot study indicates that oral alendronate administration does not accelerate the rate of CAC, but a larger cohort should be studied to confirm these findings.