Sustained-release sodium fluoride in the treatment of the elderly with established osteoporosis

Background: We ascertained the safety and efficacy of fluoride in augmentin g spinal bone mass and reducing spinal fractures in older women with establ ished osteoporosis. We compared a combination of sustained-release sodium f luoride, calcium citrate, and cholecalciferol (SR-NaF group) with calcium a nd cholecalciferol alone (control group). Methods: Eighty-five ambulatory women aged 65 years or older with 1 or more nontraumatic vertebral compression fractures were enrolled in a 42-month r andomized, double-blind, placebo-controlled trial. Primary outcome measures were vertebral fracture rate, bone mass, and safety. Results: The vertebral fracture rate determined by means of computer assist ance in the SR-NaF group was significantly lower than that in the control g roup (relative risk [RR], 0.32; 95% confidence interval [CI], 0.14-0.73; P= .007). Results of visual adjudicated inspection also confirmed a significan t reduction in fracture rate (RR, 0.40; 95% CI, 0.17-0.95; P=.04). Bone min eral density in L2 through L4 increased significantly from baseline in the SR-NaF group by 5.4% (95% CI, 2.7%-8.2%; P < .001), and by 3.2% in the cont rol group (95% CI, 0.8%-5.6%; P=.01). The between-group differences in bone mineral density were not significant. The femoral neck and total hip bone mineral density remained stable in the SR-NaF group and was not significant ly different from that of the control group. There were no significant diff erences in adverse effects between groups. Conclusion: The SR-NaF group significantly decreased the risk for vertebral fractures and increased spinal bone mass without reducing bone mass at the femoral neck and total hip.