Osteoporosis International

, Volume 24, Issue 8, pp 2345–2352

Effectiveness of risedronate and alendronate on nonvertebral fractures: an observational study through 2 years of therapy

  • R. Lindsay
  • N. B. Watts
  • J. L. Lange
  • P. D. Delmas
  • S. L. Silverman
Original Article

DOI: 10.1007/s00198-013-2332-7

Cite this article as:
Lindsay, R., Watts, N.B., Lange, J.L. et al. Osteoporos Int (2013) 24: 2345. doi:10.1007/s00198-013-2332-7



This observational study showed that after 2 years, both risedronate and alendronate lowered the risk of hip and nonvertebral fractures compared with patients filling in a single bisphosphonate prescription.


Post hoc analyses of the placebo-controlled trials suggested earlier effects for risedronate (6–12 months) than for alendronate (18–24 months). The present study extends our 1-year observational data that confirmed an earlier fracture reduction with risedronate and evaluated the absolute and relative effectiveness of alendronate and risedronate in clinical practice over 2 years.


We observed three cohorts of women aged 65 years and older who initiated once-a-week dosing of bisphosphonate therapy; (1) patients adherent to alendronate (n = 21,615), (2) patients adherent to risedronate (n = 12,215), or (3) patients filling only a single bisphosphonate prescription (n = 5,390) as a referent population. Proportional hazard modeling compared the incidence of hip and nonvertebral fractures among the cohorts over 2 years after the initial prescription.


In this cohort, we previously showed at 12 months a significant reduction of hip and nonvertebral fractures with risedronate but not with alendronate. At the end of 2 years, the cumulative incidence of hip fractures in the referent cohort was 1.9 %, and incidence of nonvertebral fractures was 6.3 %. Relative to the referent, 6 months after initiating therapy and continuing through 2 years, both risedronate and alendronate cohorts had approximately a 45 % lower incidence of hip fractures and a 30 % lower incidence of nonvertebral fractures.


These observations suggest that both risedronate and alendronate are effective at reducing the risk of hip and nonvertebral fracture after 2 years of treatment and support the post hoc analyses of placebo-controlled trials indicating an earlier effect of risedronate.





Confidence interval


International Classification of Diseases, 9th Revision, Clinical Modification

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • R. Lindsay
    • 1
  • N. B. Watts
    • 2
  • J. L. Lange
    • 3
  • P. D. Delmas
    • 4
  • S. L. Silverman
    • 5
  1. 1.Helen Hayes HospitalWest HaverstrawUSA
  2. 2.Mercy Health Osteoporosis and Bone Health ServicesCincinnatiUSA
  3. 3.Procter & GambleMasonUSA
  4. 4.INSERM Unit 403Université Claude Bernard Lyon 1LyonFrance
  5. 5.Cedars-Sinai Medical Center and University of CaliforniaLos AngelesUSA