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Risedronate
A Clinical Review
Carolyn Crandall, MD
Arch Intern Med. 2001;161:353-360.
Background Risedronate sodium has recently been approved for the prevention and
treatment of postmenopausal and corticosteroid-induced osteoporosis.
Methods Studies of risedronate were obtained from the MEDLINE database (1966
to the present) of references using risedronate, risedronic
acid, osteoporosis, and human subject as keywords.
Additional references were sought from the reference lists of the articles
obtained.
Results Nine randomized controlled trials and 7 other clinical trials were obtained.
In postmenopausal women with normal bone density, risedronate increases lumbar
spine bone density and preserves femoral neck density. In postmenopausal women
with prior vertebral fracture, risedronate decreases new vertebral and nonvertebral
fracture incidence. In patients who experienced breast cancer and who have
chemotherapy-induced menopause, risedronate preserves bone. Risedronate prevents
vertebral bone loss in patients beginning long-term corticosteroid therapy.
Risedronate decreases pagetic bone pain and induces radiological improvement
in pagetic lesions. Risedronate induces normalization of biochemical abnormalities
and may be more effective than etidronate disodium for Paget disease. Only
one study, a trial in patients with postmenopausal osteoporosis using a low
dose (2.5 mg) of risedronate, did not have a positive result. Adverse effects
in patients with postmenopausal osteoporosis, breast cancer, and Paget disease
and in those taking corticosteroids are similar to those of patients taking
placebo, and do not include notable upper gastrointestinal tract adverse event
rates or serious adverse events.
Conclusions Risedronate prevents postmenopausal bone loss, decreases fracture in
those with established postmenopausal osteoporosis, effectively treats Paget
disease, and prevents corticosteroid-induced bone loss. Long-term toxic effects
and efficacy, particularly fracture end point data, are unknown. Also undefined
are optimal duration of therapy, potential for use in combination with other
agents, and direct comparison with other bisphosphonates used for osteoporosis.
From the Department of Medicine, University of California, Los Angeles,
UCLA School of Medicine.
Corresponding author and reprints: Carolyn Crandall, MD, Department
of Medicine, University of California, Los Angeles, UCLA School of Medicine,
UCLA National Center of Excellence in Women's Health (US Department of Health
and Human Services), Iris Cantor–UCLA Women's Health Center, 100 UCLA
Medical Plaza, Suite 250, Los Angeles, CA 90095-7023 (e-mail: ccrandall{at}mednet.ucla.edu).
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