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There is a great interest in examining the evidence for an interaction of FRAX® probabilities with drug efficacy. A recent article from Kanis and colleagues [1] has evaluated the distribution of fracture risk assessed at baseline using the FRAX tool in the MORE study and has determined the efficacy of raloxifene as a function of baseline fracture risk. 


They concluded that raloxifene (both 60 and 120 mg doses) significantly decreased the risk of all clinical fractures (18%; hazard ratio (HR )  0.82; 95% confidence interval (CI) 0.71–0.95; [i]p[/i] = 0.0063) and morphometric vertebral fractures (42%; HR 0.58; 95% CI 0.48–0.69; [i]p[/i] = 0.001). Efficacy was shown over the whole range of fracture probability and the interaction between fracture probability and treatment was not significant.


  • Santiago Palacios
    Director of the Palacios Institute of Womens Health, Madrid, Spain


  1. Kanis JA, Johansson H, Oden A, et al. A meta-analysis of the efficacy of raloxifene on all clinical and vertebral fractures and its dependency on FRAX. Bone 2010;47:729-35.
  2. Kanis JA, on behalf of the World Health Organization Scientific Group. Assessment of osteoporosis at the primary health-care level. WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK, 2007.
  3. Kanis JA, Johnell O, Oden A, et al. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 2008;19:385-97.
  4. Kanis JA, Johansson H, Oden A, McCloskey EV. Bazedoxifene reduces vertebral and clinical fractures in postmenopausal women at high risk assessed with FRAX. Bone 2009;44:1049-54.
  5. McCloskey EV, Johansson H, Oden A, et al. Ten-year fracture probability identifies women who will benefit from clodronate therapy additional results from a double-lind, placebo-controlled randomised study. Osteoporos Int 2009;20:811-17.
  6. Ettinger B, Black DM, Mitlak BH, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 1999;282:637-45.

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