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To the editor:

We appreciate Dr. Watts’ interest in our paper. We think that we have been quite cautious in this comparison between fracture incidence in both groups. As Dr. Watts described, we provided all relevant facts for the reader. Even among published large fracture treatment studies, there is little consensus in the definition of “osteoporotic fracture,” with some studies defining osteoporotic fractures by site without regard to trauma (1); others excluding facial, skull, pathological, and traumatic fractures (2); and still others reporting all nonvertebral fractures (3). In this small study, it was possible to enumerate all nonvertebral fractures without imposing our own biases regarding the relevance of site or trauma. It is interesting, however, that all three fractures of the radius highlighted by Dr. Watts occurred in the alendronate group and none in the teriparatide group. It is evident that the study was not powered for detecting a difference in antifracture efficacy between both groups, and this was not the primary objective of this trial. Nevertheless, we think the data are interesting, provocative, and worthwhile to be reported, but we agree with Dr. Watts that they would have to be confirmed in a larger trial.

Issue Section:
Letters to the Editor
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