Drug for bone health reduces cancer, heart disease in older women

Researchers at the University of Auckland say the unexpected bonus benefits of the drug zoledronate, if confirmed by further studies, could be as significant for older women’s health and wellbeing as the drug’s fracture-preventing action.

Half of women have a fracture between menopause and the time of death, and 80 percent of these fractures occur in women with osteopenia, a less severe but more common form of bone loss than osteoporosis. One out of six women will have osteopenia at age 55, jumping to half of all women by age 75.

Zoledronate, a long-acting bisphosphonate, is commonly prescribed for osteoporosis. It works on the cells that break down bone called osteoclasts, which become overactive after menopause, causing an increased rate of bone loss.

Previous research had shown that zoledronate prevents factures in women with osteoporosis. But the University of Auckland researchers wanted to see if it also prevented fractures in women with osteopenia.

Distinguished Professor Ian Reid and Dr Anne Horne carried out a six-year, double-blind clinical trial of 2000 women aged 65 years and older with osteopenia. Half received four infusions of zoledronate at 18-month intervals, the other half received inactive infusions.

The trial’s main findings, published late last year in the high-ranking New England Journal of Medicine, represent a game-changer for fracture prevention: giving zoledronate to older women with osteopenia reduced fractures by between 35 and 50 per cent, depending on the type of fracture. It also ultimately halted the progression to osteoporosis.

Already, this finding has prompted a global rethink in how to prevent fractures in older women.

Unexpectedly, analysis also revealed that taking zoledronate reduced women’s chances of having a heart attack, or getting cancer by about a third. The researchers delved deeper into these findings and published a new paper in October in the Journal of Bone and Mineral Research.

Says Dr Horne, a research fellow in the School of Medicine, “We know that some cancers spread to bone early in their course, so having zoledronate coating the bones may prevent these cancer cells attaching to bone and establishing themselves there. We also think that zoledronate may bind to the calcium in the walls of blood vessels, stabilising them and preventing the progression of arterial wall damage so that people suffer less heart attacks.”

Distinguished Professor Reid says, “These extra effects of zoledronate, if borne out by future research, could have as great – or even greater – impact on older women’s health as fracture prevention. We now need studies specifically designed to test them.”

The Auckland clinical trial was funded by the New Zealand Health Research Council, which awarded the researchers its prestigious Liley Medal this month for their significant medical breakthrough.

Read the articles:

Journal of Bone and Mineral Research: Effects of zoledronate on cancer, cardiac events, and mortality in osteopenic older women

New England Medical Journal: Fracture prevention with zoledronate in older women with osteopenia