Risedronate (
Actonel 35 mg), which was promoted in Croatia a few months ago, is the latest (III) generation of
bisphosphonates, the most efficient anti-resorption drugs that inhibit osteoclast-mediated
bone resorption and change the bone metabolism. The effect of
risedronate is 10 times stronger than that of
alendronate, and 10.000 times stronger than that of
etidronate. The bone turnover is reduced while the osteoblast activity and bone mineralisation are preserved. Decreases in
biochemical markers of bone turnover were observed as soon as within 1 month and reached a maximum in 3-6 months of
Actonel 35 mg application once a week or 5 mg a day. Several major international, randomised and placebo controlled clinical studies (VERT-NA, VERT-MN, HIP...) on more than 15,000 patients over 3-5 years of
therapy have confirmed the speed, efficacy and excellent tolerability of
risedronate in treating postmenopausal and
corticosteroid-induced
osteoporosis. After only 6 months of treatment VERT-NA and VERT-MN have shown a significant reduction in vertebral fracture risk versus control group, radiographically by 62% and clinically by 69% in the first year, which remains significant even after 5 years of treatment (50%) of
postmenopausal osteoporosis. All the best properties of
bisphosphonates have also been confirmed through a significant reduction in the relative risk of
femoral neck fracture over 3 years of treatment by 40%, or by as much as 60% in female patients with
osteoporosis and prevalent vertebral fracture, compared with controls. With
risedronate we can achieve a quick and significant reduction in vertebral fracture risk in postmenopausal women (65%), especially among a high-risk population such as patients on long-term
glucocorticoid therapy (70%) in the very first year of treatment. Prevention and treatment of
glucocorticoid-induced
osteoporosis is recommended in the administration of 27,5 mg of
prednisone or
prednisone equivalent in a duration longer than 3 months, irrespective of age or gender. Tolerability and safety of
risedronate administration in
osteoporosis is very good, almost the same as in the control group, although patients with earlier described or ongoing gastrointestinal troubles were also included. The incidence of endoscopically confirmed
gastric ulcer in treatment with
alendronate is significantly higher (13,2%) versus controls than in treatment with
risedronate (4,1%).
Risedronate is hence the first line of
bisphosphonates for the reduction of vertebral and non-vertebral fracture risks in postmenopausal women with
osteoporosis or those with a high risk of
osteoporosis. It also efficiently prevents bone loss or improves bone density in men and women on a long-term
corticosteroid therapy.