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To the Editor: The optimal duration of alendronate treatment is an important issue. In the FLEX study by Dr Black and colleagues,¹ 1099 women previously enrolled in the FIT trial who completed 5 years of alendronate were randomized to continue alendronate or to receive placebo for another 5 years. The overall fracture incidence was not different between the 2 groups, suggesting that alendronate discontinuation might be reasonable in most patients. This study raises a number of issues.

First, the similar nonvertebral fracture rates in patients continuing or stopping alendronate is difficult to interpret, because in both groups of the FIT trial, there was no significant decrease in nonvertebral fracture incidence with alendronate compared with placebo.^2-3 During FLEX, the incidence of morphometric vertebral fractures was not different between both groups, while those coming to clinical attention (37% of total) were reduced by half in patients continuing alendronate. This discrepancy should be . . . [Full Text of this Article]

Pierre D. Delmas, MD, PhD
delmas@lyon.inserm.fr
Université Claude Bernard Lyon 1
Lyon, France

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