#189 Bisphosphonates and Fracture Prevention Trial: Beyond Journal Club with NEJM Group

Core IM | Internal Medicine Podcast

Core IM Team

Mental Health, Education, Health & Fitness, Medicine

4.8 • 1K Ratings

🗓️ 1 October 2025

⏱️ 35 minutes

🔗️ Recording | iTunes | RSS

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Summary

Who’s really at risk for fractures, and how should we be treating them?

Most fragility fractures occur in patients without osteoporosis. Should we rethink who gets treated? And could just one or two IV infusions (spread years apart) of zoledronate prevent fractures for years? Have the concerns about bisphosphonates been overblown?

Find out all the nuances on this episode of Beyond Journal Club, a series brought to you by Core IM in collaboration with NEJM Group.

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🔹 Transcript & Show Notes

Timestamps:

(00:59) | Diagnosing Osteoporosis and Hidden Fracture Risk

(05:38) | Evolution of Bisphosphonate Use in Osteoporosis Treatment

(07:51) | Current Use of Bisphosphonates: Benefits, Risks, and Side Effects

(10:31) | Exploring Non-Bisphosphonate Options for Fracture Prevention

(11:44) | Teriparatide and Alternative Osteoporosis Medications

(14:53) | Inside the Latest Bisphosphonate Clinical Trial

(18:07) | Key Findings from the Zoledronate Fracture Prevention Study

(22:38) | Public Health Impact of Fracture Prevention Strategies

(24:24) | Final Takeaways and Expert Perspectives on Osteoporosis Care

Tags: CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Osteoporosis, Fragility Fractures, Zoledronate, Bone Health

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Transcript

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0:00.0	Welcome to Beyond Journal Club, a collaboration patient quorum and NEJM group.
0:04.0	The goal of Beyond Journal Club is to take landmark clinical trials and put them into context, telling the story of how we got to where we are, what it means for our patients, and how we take care of them. I'm Dr. Shire Trevetty, internist of Bethesial Deaconess Medical Center. I'm Dr. Greg Katz, cardiologist at NYU. I'm Dr. Flemley at Metpice Hospice in Boston, and a guest editor at E.JM. And I'm Dr. Sarigori, a previous editorial fellow at the New England Journal of Medicine and a geriatric medicine fellow at Beth Israel DeKanes medical center. Today we're diving into the world of bone health, and we're going to be talking about how well do bisphosphonates prevent fractures.
0:39.9	We'll be looking at a recent trial by Boland et al of infrequent zillendronate therapy in patients without osteoporosis to prevent fractures, which was published in the New England Journal of Medicine in January 2025.
0:51.9	And before you all jump on me asking me this question, yes, I am very bummed that there is no
0:56.5	cool acronym for this trial.
0:59.7	Too bad.
1:00.5	So sad.
1:01.3	That's what my five-year-old would say.
1:03.8	Too bad.
1:04.5	So sad.
1:05.2	And so moving on, before we get into the study itself, we'll discuss first how to make a
1:09.5	diagnosis of osteoporosis and talk about
1:11.5	why just making that diagnosis doesn't actually tell us everything we need to know about who
1:15.7	should be treated with preventive medicines to reduce fracture risk. Then we'll go over what
1:20.0	drugs we actually have in our toolkit for fracture prevention and more importantly, what is missing
1:24.7	and why this nubis phosphonite trial was so compelling.
1:28.3	And finally, we'll bring it home to discuss if this changes our practice and how we prevent
1:32.1	fractures in our patients.
1:38.6	Whether you're in the thick of residency or just try to survive a stretch of 12, you probably
1:43.9	don't need one more thing on your
1:45.6	plate and that's where Oakstone Sammy comes in. They actually get it. Oakstone isn't trying to
1:50.8	pile up one more thing on the checkbox. It's supporting you and CME that adapts to you, not the
	...

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