We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comment & Response |

Dosing Strategies of Bone-Targeting Agents

Chika Edward Uzoigwe, MRCS, MRCP1
[+] Author Affiliations
1Department of Orthopaedics, Harcourt Building, Sheffield, United Kingdom
JAMA Intern Med. 2015;175(11):1865. doi:10.1001/jamainternmed.2015.4796.
Text Size: A A A
Published online


To the Editor The study by Greenspan et al1 is laudable and significant in that it focuses on a neglected but expanding cohort of patients. The group evaluated the efficacy of zolendronic acid. The study included patients with previous fragility fractures. Greenspan et al also permitted patients on bisphosphonate and/or alternative antiresorptive therapy coincident with the time of original fragility fractures. Patients were only excluded if medicated on bisphosphonate at the time of recruitment or if they had been taking a bisphosphonate for over 1 year within 2 years of trial recruitment. Unsurprisingly, in my view, they found zolendronate not to be protective against fragility fractures in this group in this context. The selection process involved the accumulation of bisphosphonate and/or antiresorptive failures. This is index event bias (also known as collider stratification bias), also articulated in JAMA.2 Those with a fragility fracture while receiving bisphosphonate or other antiresorptive treatment are likely to find a substitute or new concurrent bisphosphonate ineffective or weakly protective.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





November 1, 2015
Brian Hutton, PhD; Sasha Mazzarello, BSc; Mark Clemons, MD
1Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
2Division of Medical Oncology, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
JAMA Intern Med. 2015;175(11):1864-1865. doi:10.1001/jamainternmed.2015.4789.
November 1, 2015
Susan L. Greenspan, MD; Subashan Perera, PhD; Neil M. Resnick, MD
1Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
JAMA Intern Med. 2015;175(11):1865-1866. doi:10.1001/jamainternmed.2015.4799.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...