Fracture Prevention with Zoledronate in Older Women with Osteopenia

To the Editor: In the trial reported by Reid et al. (Dec. 20 issue), 1 zoledronic acid led to a lower risk of fragility fractures than placebo among postmenopausal women with osteopenia. We have concerns about the conclusion. First, nonvertebral fractures were seen in 24% of the participants at screening. A clinical diagnosis of osteoporosis includes the presence of fragility fractures. 2,3 Thus, more than 24% of the participants actually had osteoporosis rather than osteopenia. Second, if the 10-year risk of major osteoporotic fractures among women with osteopenia is estimated to be 3.9% by the Fracture Risk Assessment Tool (FRAX; developed by . . .