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Characteristics Associated with Bone Mineral Density Responses to Alendronate in Men
Authors:Erik D. Swenson  Karen E. Hansen  Andrea N. Jones  Zhanhai Li  Brooke Baltz-Ward  Arthur A. Schuna  Mary E. Elliott
Affiliation:1. Mercy Arthritis and Osteoporosis Center, Urbandale, IA, 50322, USA
2. School of Medicine and Public Health, University of Wisconsin, Madison, WI, 53705, USA
3. Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, 53705, USA
4. Northwestern Memorial Hospital, Chicago, IL, 60611, USA
5. William S. Middleton Veterans Affairs Medical Center, Madison, WI, 53705, USA
6. School of Pharmacy, University of Wisconsin, 777 Highland Avenue, Madison, WI, 53705, USA
Abstract:Some patients experience reduced bone mineral density (BMD) despite bisphosphonate therapy. We performed a retrospective chart review study to detect factors associated with decreased BMD in men prescribed alendronate. Two investigators reviewed eligible medical records and used a standardized form to record potential characteristics predicting men’s response to alendronate. We analyzed patient characteristics associated with annualized change in hip and spine BMD (D-BMD). Among 115 eligible men, 19 (17 %) experienced significantly decreased BMD at the hip or spine, defined as a change exceeding precision error. Eleven men (10 %) fractured during therapy. Spine D-BMD was positively associated with adherence to alendronate (R = 0.23, p = 0.02) and inversely associated with baseline body weight (R = ?0.21, p = 0.03). Hip D-BMD was positively associated with annualized weight change (R = 0.19, p = 0.0498) and negatively associated with patient age and number of concomitant medications (R = ?0.21, p = 0.03; R = ?0.20, p = 0.03, respectively). In stepwise linear models, spine D-BMD was associated positively with alendronate adherence and multivitamin use and negatively with baseline body weight. Hip D-BMD was negatively associated with age. Fracture during treatment was associated with fracture prior to therapy (p = 0.03). In this small study of men prescribed alendronate, BMD response showed a positive association with adherence to therapy, weight gain, and use of a multivitamin. By contrast, older age, higher baseline body weight, and higher number of medications were each associated with a decrease in BMD. Larger studies are needed to confirm and extend these findings.
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