Background Post-hoc analyses of pivotal studies for osteoporosis therapies such as alendronate1 and strontium ranelate2 have demonstrated a reduction in the progression of spinal structural osteoarthritis (OA) measures. There is strong data demonstrating that subchondral bone alterations in osteoarthritis are involved in cartilage degradation. In knee osteoarthritis, zoledronic acid (ZA) improved pain and decreased bone marrow lesion size over 6 months3. ZA helps back pain and this benefit is independent of changes in bone mass and fracture4 suggesting a possible effect on OA. However, there is no data at present on whether ZA influences radiographic OA. We analyzed data from the HORIZON PFT study, in which osteoporotic post-menopausal women were randomised to 36 months of yearly ZA or placebo for fracture reduction. Our aim in this post-hoc analysis was to explore the effect of ZA on spinal osteophytes and disc space narrowing.
Objectives To assess whether administration of ZA delays the structural progression of spinal osteophytes or disc space narrowing in those with pre-exiting spinal radiographic osteoarthritis.
Methods A post-hoc blinded analysis of the spinal radiographs HORIZON PFT study was undertaken on a subset of paired spinal radiographs. Post menopausal women that received at least one dose of study medication, and who had both baseline and 36 month spinal radiographs, with a non zero score for spinal osteophytes at baseline were included. Xray scoring of paired images was performed, using the current gold standard method for osteoarthritis5; separately for osteophytes and disc narrowing at all evaluable levels from T4–12 and L1–5.
Results 505 sets of paired radiographs were included in the analysis; 245 in the ZA group and 260 in the placebo group. Overall, rates of change were low but were not different between groups (see table).
Conclusions ZA was not associated with a slowing of progression of osteophytes or disc space narrowing in the thoraco-lumbar spine in this cohort.
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Acknowledgement This work was supported by a Healy Research Collaboration Award from The Raine Medical Research Foundation, University of Western Australia
Disclosure of Interest None declared
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