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Evidence that Treatment with Risedronate in Women with Postmenopausal Osteoporosis Affects Bone Mineralization and Bone Volume

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Abstract

Risedronate is used in osteoporosis treatment. Postmenopausal women enrolled in the Vertebral Efficacy with Risedronate Therapy trial received either risedronate (5 mg/day) or placebo for 3 years. Subjects received calcium and vitamin D supplementation if deficient at baseline. Lumbar spine bone mineral density (BMD) was measured at baseline and at 3 years. Quantitative back-scattered electron imaging (qBEI) was performed on paired iliac crest biopsies (risedronate, n = 18; placebo, n = 13) before and after treatment, and the mineral volume fraction in the trabecular bone was calculated. Combining dual-energy X-ray absorptiometric values with the mineral volume fraction for the same patients allowed us to calculate the relative change in trabecular bone volume with treatment. This showed that the effect on BMD was likely to be due partly to changes in matrix mineralization and partly due to changes in bone volume. After treatment, trabecular bone volume in the lumbar spine tended to increase in the risedronate group (+2.4%, nonsignificant) but there was a significant decrease (−3.7%, P < 0.05) in the placebo group. Calcium supplementation with adequate levels of vitamin D led to an ∼3.3% increase in mineral content in the bone material independently of risedronate treatment. This increase was larger in patients with lower matrix mineralization at baseline and likely resulted from correction of calcium/vitamin D deficiency as well as from reduced bone remodeling. Combining BMD and bone mineralization density distribution data show that in postmenopausal osteoporosis 3-year treatment with risedronate preserves or may increase trabecular bone volume, unlike placebo. This analysis also allows, for the first time, separation of the contributions of bone volume and matrix mineralization to the increase in BMD.

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Acknowledgement

We thank Gerda Dinst, Sabrina Thon, and Daniela Gabriel (Bone Material Laboratory of the Ludwig Boltzmann Institute of Osteology, Vienna, Austria) for the sample preparation. This work was supported in part by the FWF—Fonds zur Förderung der wissenschaftlichen Forschung (Austrian Science Fund) (grant P16880-B13) and by a research grant from The Alliance for Better Bone Health. Support was also received from the Austrian Social Insurance for Occupational Risk and the Social Health Insurance Vienna.

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Authors and Affiliations

  1. Department of Biomaterials, Max Planck Institute of Colloids and Interfaces, Research Campus Golm, D-14424, Potsdam, Germany

    Peter Fratzl

  2. Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 4th Medical Department, Hanusch Hospital, 1140, Vienna, Austria

    Paul Roschger, Nadja Fratzl-Zelman, Eleftherios P. Paschalis & Klaus Klaushofer

  3. Procter & Gamble Pharmaceuticals, Mason, Ohio, USA

    Roger Phipps

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  1. Peter Fratzl
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  6. Klaus Klaushofer
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Correspondence to Peter Fratzl.

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Fratzl, P., Roschger, P., Fratzl-Zelman, N. et al. Evidence that Treatment with Risedronate in Women with Postmenopausal Osteoporosis Affects Bone Mineralization and Bone Volume. Calcif Tissue Int 81, 73–80 (2007). https://doi.org/10.1007/s00223-007-9039-8

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