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July 28, 1999

Alendronate and Fracture Prevention—Reply

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;282(4):324-325. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-4-jbk0728

In Reply: Dr Cummings and colleagues are correct in noting that those alendronate-treated patients in their trial who had the most severe bone loss did experience a significant reduction in fracture risk, a fact that I had acknowledged explicitly in my editorial. There is, thus, no disagreement there. But they are silent on my 2 main points: (1) the inadequacy of the bone mass paradigm as an explanation for osteoporotic fragility, and (2) the issue of what the physician ought to do when confronted with patients with bone mass values in the range that the World Health Organization Working Group1 defined as osteopenia (ie, bone mineral density values between −2.5 and −1.0 SDs).

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