Cheap and widely available, nitroglycerin is known to stimulate bone formation and inhibit bone resorption. Might it have a role to play in the treatment of bone loss? Jamal and colleagues from the University of Toronto and other centres did a double-blind, placebo-controlled trial of 243 postmenopausal women with lumbar spine T scores of between 0 and - 2.0.1 The women were randomised to receive either nitroglycerin ointment (15 mg/d) or placebo applied every night at bedtime, over a 2-year period. After 2 years, those who used nitroglycerin had a modest but significant improvement in bone density in the lumbar spine, femoral neck, and total hip compared with placebo. Hence, nitroglycerin might be useful in preventing fractures, say the authors. A larger study of the effects of nitroglycerin in preventing fractures is needed, writes Dr Sundeep Khosla from Mayo Clinic in an accompanying editorial.2
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