Bouxsein ML, et al. – According to meta-analyses of osteoporosis trials conducted over 15 years ago, improvements in bone mineral density (BMD) are associated with reduced vertebral and nonvertebral fractures. To further investigate this association, researchers undertook a meta-regression of 38 placebo-controlled trials of 19 therapeutic agents. They noted 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. While these results cannot be applied directly to predict an individual patient's treatment benefit, they provide compelling evidence that BMD improvements with osteoporosis therapies can be useful surrogate endpoints for fracture in new therapeutic agent trials.