Original Article

Osteoporosis International

, Volume 18, Issue 1, pp 25-34

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Effectiveness of bisphosphonates on nonvertebral and hip fractures in the first year of therapy: The risedronate and alendronate (REAL) cohort study

  • S. L. SilvermanAffiliated withCedars-Sinai Medical Center and David Geffen School of Medicine at the University of California Los Angeles Email author 
  • , N. B. WattsAffiliated withBone Health and Osteoporosis Center, University of Cincinnati
  • , P. D. DelmasAffiliated withINSERM Unit 403, Université Claude Bernard Lyon 1
  • , J. L. LangeAffiliated withP&G Pharmaceuticals
  • , R. LindsayAffiliated withHelen Hayes Hospital



Randomized clinical trials have shown that risedronate and alendronate reduce fractures among women with osteoporosis. The aim of this observational study was to observe, in clinical practice, the incidence of hip and nonvertebral fractures among women in the year following initiation of once-a-week dosing of either risedronate or alendronate.


Using records of health service utilization from July 2002 through September 2004, we created two cohorts: women (ages 65 and over) receiving risedronate (n = 12,215) or alendronate (n = 21,615). Cox proportional hazard modeling was used to compare the annual incidence of nonvertebral fractures and of hip fractures between cohorts, adjusting for potential differences in risk factors for fractures.


There were 507 nonvertebral fractures and 109 hip fractures. Through one year of therapy, the incidence of nonvertebral fractures in the risedronate cohort (2.0%) was 18% lower (95% CI 2% – 32%) than in the alendronate cohort (2.3%). The incidence of hip fractures in the risedronate cohort (0.4%) was 43% lower (95% CI 13% – 63%) than in the alendronate cohort (0.6%). These results were consistent across a number of sensitivity analyses.


Patients receiving risedronate have lower rates of hip and nonvertebral fractures during their first year of therapy than patients receiving alendronate.


Bisphosphonates Epidemiology Hip fractures Nonvertebral fractures Osteoporosis