Among women who continued treatment for 24 months, headaches were reported by 40 (35%) nitroglycerin users versus six (5.4%) nonusers during the first month, decreasing substantially after 12 months.
WHAT THIS EVIDENCE MEANS FOR PRACTICE
At this time, no changes in clinical practice are warranted. However, the findings of Jamal and coworkers should set the stage for a larger, adequately powered study of nitroglycerin ointment, using fracture as an outcome. If such a study demonstrates fracture reduction, clinicians will have a novel and inexpensive therapy for osteoporosis. The findings of Jamal and coworkers also should prompt development of additional nitric oxide donors that have greater skeletal effects and a better adverse-effect profile—particularly in regard to headache.
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