Infrequent Zoledronate — Small Individual Gain, Larger Population Gain

Fragility fractures impose substantial burdens on postmenopausal women, with approximately 75% occurring in individuals with bone mineral density classified as normal or indicative of osteopenia rather than osteoporosis. Despite the availability of effective therapies, treatment remains underutilized. Zoledronate, a bisphosphonate, offers long-term fracture protection with infrequent dosing. A 10-year, randomized, placebo-controlled trial demonstrated that administering zoledronate at baseline and five years significantly reduced vertebral fractures compared with placebo, with relative risk reductions of approximately 40%. This editorial highlights the implications of primary prevention strategies using infrequent zoledronate administration, emphasizing the benefits at a population level despite modest individual gains. The findings support broader prevention approaches targeting individuals at risk, rather than limiting treatment to those diagnosed with osteoporosis.

Fragility fractures impose substantial burdens on postmenopausal women, with approximately 75% occurring in individuals with bone mineral density classified as normal or indicative of osteopenia rather than osteoporosis. Despite the availability of effective therapies, treatment remains underutilized. Zoledronate, a bisphosphonate, offers long-term fracture protection with infrequent dosing. A 10-year, randomized, placebo-controlled trial demonstrated that administering zoledronate at baseline and five years significantly reduced vertebral fractures compared with placebo, with relative risk reductions of approximately 40%. This editorial highlights the implications of primary prevention strategies using infrequent zoledronate administration, emphasizing the benefits at a population level despite modest individual gains. The findings support broader prevention approaches targeting individuals at risk, rather than limiting treatment to those diagnosed with osteoporosis.