What is the use of Risedronate (Bisphosphonate)?

From the Guidelines

Risedronate is a first-line bisphosphonate medication used to treat and prevent osteoporosis in both postmenopausal women and men, primarily to reduce the risk of hip and vertebral fractures. The standard dosage is typically 35 mg once weekly or 150 mg once monthly, taken first thing in the morning with a full glass of plain water, at least 30 minutes before consuming any food, beverages, or other medications 1. Patients should remain upright (sitting or standing) for at least 30 minutes after taking risedronate to prevent esophageal irritation. For osteoporosis treatment, the medication is usually prescribed for 3-5 years, after which a drug holiday may be considered based on fracture risk assessment. Risedronate works by inhibiting osteoclast activity, which slows bone resorption and helps maintain bone density.

Some key points to consider when prescribing risedronate include:

• Common side effects include gastrointestinal disturbances, musculoskeletal pain, and headache
• Rare but serious side effects can include osteonecrosis of the jaw and atypical femur fractures, particularly with long-term use
• Adequate calcium (1000-1200 mg daily) and vitamin D (800-1000 IU daily) supplementation should accompany risedronate therapy for optimal effectiveness in bone health management
• Factors associated with poor adherence to bisphosphonate therapy include side effects, inconvenience of taking medications, absence of symptoms for underlying disease, comorbid conditions, age, and socioeconomic status 1

According to the most recent and highest quality study, bisphosphonates, including risedronate, should be used as first-line treatment in both females and males with primary osteoporosis due to their favorable balance of benefits, harms, patient values and preferences, and cost 1.

From the FDA Drug Label

Risedronate sodium is a bisphosphonate in a delayed-release formulation and is indicated for treatment of postmenopausal osteoporosis (1.1) The use of Risedronate (Bisphosphonate) is for the treatment of postmenopausal osteoporosis 2.

• The optimal duration of use has not been determined, but for patients at low-risk for fracture, consider drug discontinuation after 3 to 5 years of use. Key points include:
• Indication: postmenopausal osteoporosis
• Limitations of use: optimal duration of use has not been determined 2

From the Research

Uses of Risedronate

• Risedronate is used for the prevention and treatment of postmenopausal osteoporosis, reducing the risk of vertebral and non-vertebral fractures 3, 4, 5, 6.
• It is also used for the prevention and treatment of glucocorticoid-induced osteoporosis, with a positive effect on vertebral fractures within the first year 3, 4, 6.
• Risedronate is effective in reducing the risk of hip fracture in elderly women with low hip bone density and one clinical risk factor for hip fracture 3, 6.
• It is used to treat Paget's disease, with statistically significant reductions in mean serum levels of alkaline phosphatase (ALP) 3.

Mechanism of Action

• Risedronate reduces bone turnover and decreases resorption chiefly through osteoclastic effects, with no undesirable effects on cortical porosity or thickness or on cancellous bone volume 3.
• It inhibits osteoclast-mediated bone resorption and changes the bone metabolism, with a specific structure and set of characteristics that enable less frequent dosing 4, 7.

Dosage and Administration

• The recommended dose of risedronate is 5 mg/day, with the option of a once monthly regimen of 75 mg on 2 consecutive days or 150 mg once a month 3, 4, 7.
• Risedronate is well-tolerated, with a safety profile comparable to placebo in all clinical studies, and no evidence of acute-phase reactions or primary mineralisation defects 3, 6.