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Alendronate or risedronate to treat my osteoporosis, which should I choose?

Q) I'm 77 and have quite severe osteoporosis. I've been taking alendronate once a week. A recent bone density scan showed little improvement, although it's no worse. My GP recommended a daily dose of risedronate but I found I wasn't so well on that, so I'm back on the aledronate. Which one do you think would be more beneficial? My GP is open to whatever suits me.
Olive, West Midlands (Autumn 2011)

A) Alendronate and risedronate are called bisphophonates, and there are others in the class, some of which are only taken annually by injection. That you haven't lost bone is good, as the natural tendency at your age is to lose bone density, so the alendronate is working to some extent. In changing drugs there are many factors to consider. If you've been on these drugs for 10 years or more it may be time for a change. If you've recently had a fracture this might indicate that a treatment change is necessary. And there's your lifestyle to consider – smoking and alcohol accelerate bone loss and if you tend to have falls it's important to keep your bones as strong as possible. There's no easy or simple answer to your question as each case must be considered on its merit.

This answer was provided by Dr Philip Helliwell for the Autumn 2011 edition of our magazine, Arthritis Today, and was correct at the time of publication.

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