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To the Editor: The 3-year, randomized controlled trial reported by Dr Harris and colleagues¹ demonstrated that risedronate increased bone mineral density and decreased fracture incidence in postmenopausal women with established osteoporosis. Although the overall safety profile was similar in the placebo and risedronate groups, serious adverse events were more common in the treatment group.

Risedronate inhibits osteoclast-mediated bone resorption.² Vascular calcifications have similarites to bone, and macrophages in the vessel wall have both osteoclastic and osteoblastic potential.³ It is possible that subtle changes in vascular calcification occur during bisphosphonate treatment for postmenopausal osteoporosis.⁴

Postmenopausal women are at higher risk for cardiovascular disease.⁵ Changes in vascular wall calcification may render some plaques more prone to rupture and lead to an increased risk of cardiovascular events in this population. Perhaps the authors can provide information on the proportion of cardiovascular events in the treatment vs placebo groups. If there was a higher . . . [Full Text of this Article]

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JAMA. 1999;282(14):1344-1352.
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