Actonel, MRI of knee and Fosamax tolerability
Efficacy of Actonel taken once weekly. See Curr Med Res Opin. 2004 May;20(5):757-64 by Harris ST and others. PMID: 15140343. This study compared the effectiveness and tolerability of daily 5 mg risedronate (Actonel) to once-weekly doses of either 35 or 50 mg Actonel in postmenopausal women. Women also got 1 gm elemental calcium supplements and vitamin D3 if their baseline serum 25-hydroxyvitamin D3 level was low. The two-year results showed no significant difference in osteoporosis-related non-vertebral new fractures, reduction from baseline in bone turnover markers or mean percentage increase in bone mineral density (BMD) in the lumbar spine. The authors note, "Risedronate 35 mg once a week is considered the optimal dose [for those wanting] a once-a-week dosing regimen." So, as expected, Actonel once weekly performs similar to Fosamax once weekly both in terms of effectiveness and medication tolerability. There appears to be little reason to take either medication other than with the once-weekly method.
MRI imaging findings in early osteoarthritis of the knee. This is an interesting study which probably applies to a lot of us from more than one angle. As we age we develop (what we think is) osteoarthritis and this pain can be a form of transient osteoporosis. See Eur J Radiol. 2004 Jun:50(3):225-30 by Karachalios T and others. PMID: 15145481. The authors studied people with chronic knee pain in a total of 70 patients and 82 knees with a mean age of 59 years. These people had been given a clinical diagnosis of early osteoarthritis of the knee based upon conventional radiographs. However, based upon MRI studies of the knee, multiple different disorders were found. This included 70.7% with degenerative meniscal lesions with or without ruptures of the anterior cruciate ligament, osteonecrosis of the femoral and tibial condyles in 9.75%, osteophytes and degenerative articular cartilage lesions in 8.54%, transient osteoporosis in 2.44% and benign neoplasms and cysts in 6.1%. The authors note: "The existence of such a heterogeneous group of disorders in these 'early osteoarthritic knees' may explain failures in treatment and it may justify a modern MRI imaging approach to proper diagnosis." Thus, it would appear that if you have been given a diagnosis of early osteoarthritis of the knee, an MRI imaging procedure is probably needed to get a proper diagnosis of your problem. This would especially be true if your aren't responding to conventional arthritis therapy.
Upper GI and overall tolerability of alendronate (Fosamax) once weekly in patients with osteoporosis. See Curr Med Res Opin. 2004 May;20(5):699-705 by Eisman JA and others. PMID: 15140336. As you probably know if you are taking Fosamax, there has been a lot of concern about gastrointestinal problems when taking it, especially in the daily dosing regimen. This in spite of the fact that in the large clinical trials there was no difference between Fosamax and placebo as concerns GI adverse events. This is a 12-week international, multi-center, randomized, double-blind, placebo-controlled trial including 449 postmenopausal women and men with osteoporosis. Subjects were randomized to take either 70 mg once-weekly Fosamax or placebo. The outcomes measured included safety and tolerability of weekly alendronate and placebo as measured by upper GI adverse events and individuals who discontinued therapy based upon drug-related upper GI adverse events. The effectiveness of the once-weekly Fosamax was measured by measuring the change from baseline in bone turnover as measured by the urinary N-telopeptide-collagen crosslinks corrected for creatinine (NTx/Cr) assessed at 12 weeks. Basically the study found no significant difference in adverse upper GI events in the Fosamax group compared to the placebo group. They did, however, find a significant 43.3% decrease from baseline in urinary NTx/Cr which showed the Fosamax had slowed bone turnover. So, this article is important from two standpoints: It once again shows that the once-weekly Fosamax regimen does not cause upper GI adverse events, and it shows that after 12 weeks on Fosamax you can expect almost a 50% reduction in urinary NTx/Cr levels. I occasionally hear from men who are apparently not responding to some form of osteoporosis therapy and are trying another medication. This study shows that rather than waiting a year for a bone density scan to assess the effectiveness of the new medication, the urinary NTX/Cr test should be administered at baseline and after 12 weeks of therapy on the new medication to verify that it is actually working. This test could save nine months or more of ineffective therapy that wouldn't be noted until the DEXA results were found.