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To the Editor: In the FLEX study, Dr Black and colleagues¹ investigated the effects of discontinuation of alendronate in women following 5 years of use. There was no significant difference between the morphometric vertebral fracture rates in the group that switched to placebo and in the group that continued to receive alendronate. However, the percentage of clinically recognized vertebral fractures was greater in the placebo group.

It is not clear if all of the clinical fractures in the placebo group were also morphometric fractures. If they were, then 50% (23/46) of the morphometric fractures in the placebo group were also identified as clinical fractures. However, in the alendronate group, only 27% (16/60) of the morphometric fractures would have been clinical fractures. In the original FIT study, 22.6% of the morphometric fractures were identified as clinical fractures, and this increased to 30% for severe fractures (vertebral height loss >30%). On the . . . [Full Text of this Article]

Susan M. Ott, MD
smott@u.washington.edu
Division of Metabolism
University of Washington
Seattle

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