LETTERS TO THE EDITOR Hyperglycemia: An Independent Marker of In-Hospital Mortality in Patients with Undiagnosed Diabetes

that “nonvertebral fracture incidence was significantly lower in the teriparatide group than in the alendronate group.” That is technically true, but it is misleading. It is generally accepted that fractures of the toes and feet are not related to osteoporosis, and fractures of the ribs and ankles are usually not included in clinical trials to evaluate the effect of medications on osteoporotic fractures. The authors point out in the Subjects and Methods section that fractures were recorded without regard to trauma; however, information regarding the contribution of trauma to these fractures is not provided in the paper. The discussion simply states that “fracture incidence was not a primary outcome of this study and should be confirmed in a larger study.” Because this is a study “in postmenopausal women with osteoporosis,” the natural response of a casual reader would be to assume that the study showed a greater effect of teriparatide compared with alendronate on osteoporosis-related fractures. This is not the case. Table 2 shows that of the small number of fractures, only three radial fractures might be related to osteoporosis. I am concerned that the statement referenced above will be taken out of context, leading to the erroneous conclusion that teriparatide has been shown to reduce the incidence of nonvertebral osteoporotic fractures to a greater degree than alendronate, a conclusion that I do not believe can be supported by their data. Nelson B. Watts Bone Health and Osteoporosis Center, University of Cincinnati Cincinnati, Ohio 45219