Bouxsein ML, et al. - Given that researchers of meta-analyses conducted > 15 years ago have reported that improvements in bone mineral density (BMD) were associated with reduction in vertebral and nonvertebral fractures in osteoporosis trials, researchers conducted a meta-regression of 38 placebo-controlled trials of 19 therapeutic agents to determine the association between BMD improvements and fracture risk reduction. They found a strong association between greater improvements in BMD and greater reductions in vertebral and hip fractures but not nonvertebral fractures. These findings extend previous observations that greater improvements in dual-energy X-ray absorptiometry (DXA)-based BMD were correlated with higher fracture risk reductions, especially for vertebral and hip fractures. Although these results cannot be applied directly to predict the treatment benefit of a patient, they provide compelling evidence that improvements in BMD with osteoporosis therapies might be a useful substitute for fracture in new therapeutic agent trials.