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Nelson B. Watts, Efficacy of Teriparatide and Alendronate on Nonvertebral Fractures, The Journal of Clinical Endocrinology & Metabolism, Volume 88, Issue 3, 1 March 2003, Pages 1402–1405, https://doi.org/10.1210/jc.2002-021722
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To the editor:
I applaud Body et al. (1) on their recent study, but I am writing to clarify what I believe to be an important point: the statement in the abstract that “nonvertebral fracture incidence was significantly lower in the teriparatide group than in the alendronate group.” That is technically true, but it is misleading.
It is generally accepted that fractures of the toes and feet are not related to osteoporosis, and fractures of the ribs and ankles are usually not included in clinical trials to evaluate the effect of medications on osteoporotic fractures. The authors point out in the Subjects and Methods section that fractures were recorded without regard to trauma; however, information regarding the contribution of trauma to these fractures is not provided in the paper. The discussion simply states that “fracture incidence was not a primary outcome of this study and should be confirmed in a larger study.”