Men's Osteoporosis Support Group

Generic vs. branded bisphosphonates

Rheumatol Int. 2009 May 9. [Epub ahead of print]. Differences in persistence, safety and efficacy of generic and original branded once weekly bisphosphonates in patients with postmenopausal osteoporosis: 1-year results of a retrospective patient chart review analysis.

Ringe JD, Möller G. PMID: 19430791. This is a retrospective study involving 186 women who had been on bisphosphonate therapy for at least one year. Therapies included A, generic alendronate 70 mg products; B, branded alendronate (Fosamax((R))) 70 mg once weekly and C, branded risedronate (Actonel((R))) 35 mg once weekly. Patients also got 1,200 mg calcium and 800 I.U. vitamin D daily. There was an average increase in lumbar spine bone mineral density (LS-BMD) after 12 months of 2.8, 5.2 and 4.8% for the groups A, B and C, respectively. The respective mean changes at total hip BMD were 1.5, 2.9, and 3.1%. There was no significant difference in the BMD for the two branded bisphosphonates, but they both had significantly greater BMD than the generic alendronate, while there were statistically fewer patients still taking the generic at the end of the study compared to the branded bisphosphonate groups. The authors noted, “Significantly lower increases of lumbar spine and total hip BMD with generic alendronate once weekly as compared to the two branded bisphosphonate originals (Fosamax((R)), Actonel((R))) were observed.” They are unsure of the reasons for the differences at this time, but feel some of it might be due to the significantly lower degree of persistence with the generic alendronate and its higher incidence of adverse events.

Editor's comments. There is a previous Update on this site discussing several research studies on generic bisphosphonates. A couple of the studies showed potentially harmful differences among the various bisphosphonate generics when compared to branded Fosamax. This included some of the generic brands were more likely to adhere to the esophageal mucosa, and thus cause irritation, than the Fosamax. If patients note esophageal irritation and pain they are likely not to be very persistent in taking their medication, and thus not benefit by having increased BMD.

This study is probably not large enough to draw strong conclusions, but it is suggestive that the generic bisphosphonates might not be as effective as Fosamax or Actonel. So discuss this with your physician should he or she want to switch you to a generic bisphosphonate. The money savings might not be worth the problems. And watch for future studies that might clarify this issue.

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