Skip to main content
SpringerLink
Log in

A Risk-Benefit Assessment of Alendronate in the Treatment of Involutional Osteoporosis

  • Review Article
  • Risk-Benefit Assessment
  • Published:
Drug Safety Aims and scope Submit manuscript

Abstract

Osteoporosis is the most frequent metabolic condition experienced by elderly individuals. It is characterised by a low bone mass and microarchitectural deterioration of bone tissue leading to an increase in bone fragility and susceptibility to fracture. Osteoporosis constitutes a significant financial burden for health services as well as a source of pain and disability and a cause of a decrease in the quality of life for patients with the condition. Effective therapy for osteoporosis is, therefore, urgently needed. Currently, a number of different therapeutic approaches exist that have more or less proven positive effects on the incidence of fractures, for example estrogen replacement therapy, calcitonin, fluoride salts, calcium plus vitamin D supplementation and the first-generation bisphosphonate etidronate (etidronic acid).

Alendronate (alendronic acid) is an alkylaminobisphosphonate with a very potent antiresorptive capability. In contrast to etidronate, alendronate possesses an excellent ratio between its potency for inhibiting bone resorption and its potency for impairing bone formation. In addition, no case of focal or generalised osteomalacia has so far been observed with alendronate. The bioavailability of oral alendronate is poor and the agent has to be taken in a fasting state, at least 30 minutes before breakfast, with a full glass of water.

Alendronate has demonstrated its ability to increase bone mass significantly above the placebo values at any studied skeletal site in a wide variety of patient subgroups regardless of age, race, baseline rate of bone turnover or baseline bone mineral density. Alendronate is the only medication with a demonstrated positive effect on symptomatic and asymptomatic vertebral fracture rate, as well as on nonvertebral fracture rate. In clinical trials, alendronate was generally well tolerated and no significant clinical or biological adverse experiences were observed. However, postmarketing data have included reports of oesophageal lesions compatible with the diagnosis of alendronate-induced chemical oesophagitis, in around 1% of patients taking the agent. However, in the vast majority of cases alendronate tablets had been taken incorrectly. Therefore, with proper use, that is, use complying with the manufacturers administration recommendations, this potentially dangerous complication should be minimised and should not outweigh the overall positive benefit of alendronate in the prevention of fractures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Consensus development conference. Diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 1993 Jun; 94(6): 646–50

    Article  Google Scholar 

  2. Melton LJ III, Chrischilles EA, Cooper C, et al. Perspective: how many women have osteoporosis? J Bone Miner Res 1992 Sep; 7(9): 1005–10

    Article  PubMed  Google Scholar 

  3. Jensen GF, Christiansen C, Boesen J, et al. Epidemiology of postmenopausal spinal and long bone fractures. Clin Orthop 1982 Jun; 166: 75–81

    PubMed  Google Scholar 

  4. Fleisch H, Russell RGG, Francis MD. Diphosphonates inhibit hydroxyapatite dissolution in vitro and bone resorption in tissue culture and in vivo. Science 1969 Sep 19; 165(899): 1262–4

    Article  PubMed  CAS  Google Scholar 

  5. Axelrod D, Teitelbaum SL. Results of long term cyclical etidronate therapy: bone histomorphometry and clinical correlates [abstract]. J Bone Miner Res 1994 Aug; 9 Suppl. 1: S136

    Google Scholar 

  6. Wimalawansa SJ. Combined therapy with estrogen and etidronate has an additive effect on bone mineral density in the hip and vertebrae: four-year randomized study. Am J Med 1995 Jul; 99(1): 36–42

    Article  PubMed  CAS  Google Scholar 

  7. Balena R, Markatos A, Seedor JG, et al. Long-term safety of the aminobisphosphonate alendronate in adult dogs. II —Histomorphometric analysis of the L5 vertebrae. J Pharmacol Exp Ther 1996 Jan; 276(1): 277–83

    PubMed  CAS  Google Scholar 

  8. Daifotis AG, Karpf DB. Summary of safety profile and future research with alendronate. Br J Rheumatol 1997 Jun; 36 Suppl. 1: 20–3

    CAS  Google Scholar 

  9. Fleisch H. Bisphosphonates in bone disease. New York: Parthenon, 1995

    Google Scholar 

  10. Schenk R, Eggli P, Fleisch H, et al. Quantitative morphometric evaluation of the inhibitory activity of new amino-bisphosphonates on bone resorption in the rat. Calcif Tissue Int 1986 Jun; 38(6): 342–9

    Article  PubMed  CAS  Google Scholar 

  11. Schweitzer DH, Oostendorp-Van De Ruit M, Van Der Pluijm G, et al. Interleukin-6 and the acute phase response during treatment of patients with Paget’s disease with the nitrogen-containing bisphosphonate dimethylamino-hydroxypropylidene bisphosphonate. J Bone Miner Res 1995 Jun; 10(6): 956–62

    Article  PubMed  CAS  Google Scholar 

  12. Lufkin EG, Argueta R, Whitaker MD, et al. Pamidronate: an unrecognized problem in gastrointestinal tolerability. Osteoporosis Int 1994 Nov; 4(6): 320–2

    Article  CAS  Google Scholar 

  13. Balena R, Toolan BC, Shea M, et al. The effects of 2-year treatment with the aminobisphosphonate alendronate on bone metabolism, bone histomorphometry, and bone strength in ovariectomized nonhuman primates. J Clin Invest 1993 Dec; 92(6): 2577–86

    Article  PubMed  CAS  Google Scholar 

  14. Lafage M-H, Balena R, Battle MA, et al. Comparison of alendronate and sodium fluoride effects on cancellous and cortical bone in minipigs. A one year study. J Clin Invest 1995 May; 95(5): 2127–33

    Article  PubMed  CAS  Google Scholar 

  15. Peter CP, Guy J, Shea M, et al. Long-term safety of the aminobisphosphonate alendronate in adult dogs. I. General safety and biomechanical properties of bone. J Pharmacol Exp Ther 1996 Jan; 276(1): 271–6

    PubMed  CAS  Google Scholar 

  16. Lin JH, Duggan DE, Chen IW, et al. Physiological disposition of alendronate, a potent anti-osteolytic bisphosphonate, in laboratory animals. Drug Metab Dispos 1991 Sep–Oct; 19(5): 926–32

    PubMed  CAS  Google Scholar 

  17. Roux C, Listrat V, Villette B, et al. Long-lasting dermatological lesions after tiludronate therapy. Calcif Tiss Int 1992 Apr; 50(4): 378–80

    Article  CAS  Google Scholar 

  18. Gertz BJ, Holland SD, Kline WF, et al. Studies of the oral bioavailability of alendronate. Clin Pharmacol Ther 1995 Sep; 58(3): 288–98

    Article  PubMed  CAS  Google Scholar 

  19. Chesnut CH III, McClung MR, Ensrud KE, et al. Alendronate treatment of the postmenopausal osteoporotic woman: effect of multiple dosages on bone mass and bone remodelling. Am J Med 1995 Aug; 99(2): 144–52

    Article  PubMed  CAS  Google Scholar 

  20. Adami S, Passeri M, Ortolani S, et al. Effects of oral alendronate and intranasal salmon calcitonin on bone mass and biochemical markers of bone turnover in postmenopausal women with osteoporosis. Bone 1995 Oct; 17(4): 383–90

    Article  PubMed  CAS  Google Scholar 

  21. Devogelaer JP, Broil H, Correa-Rotter R, et al. Oral alendronate induces progressive increases in bone mass of the spine, hip, and total body over 3 years in postmenopausal women with osteoporosis. Bone 1996 Feb; 18(2): 141–50

    Article  PubMed  CAS  Google Scholar 

  22. Tucci JR, Tonino RP, Emkey RD, et al. Effect of three years of oral alendronate treatment in postmenopausal women with osteoporosis. Am J Med 1996 Nov; 101(5): 488–501

    Article  PubMed  CAS  Google Scholar 

  23. Bone HG, Downs RW, Tucci JR, et al. Dose-response relationships for alendronate treatment in osteoporotic elderly women. J Clin Endocrinol Metab 1997 Jan; 82(1): 265–74

    Article  PubMed  CAS  Google Scholar 

  24. Favus M, Emkey R, Leite M, et al. Five-year treatment of osteoporosis in postmenopausal women with oral alendronate: effects on bone mass and turnover and safety [abstract]. J Bone Miner Res 1997 Aug; 12 Suppl. 1: S150

    Google Scholar 

  25. Liberman UA, Weiss SR, Broil J, et al. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. N Engl J Med 1995 Nov 30; 333(22): 1437–43

    Article  PubMed  CAS  Google Scholar 

  26. Black DM, Cummings SR, Karpf DB, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 1996 Dec 7; 348(9041): 1535–41

    Article  PubMed  CAS  Google Scholar 

  27. WHO Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. World Health Organ Tech Rep Ser 1994; 843: 1–129

    Google Scholar 

  28. Minne HW, Leidig G, Wuster C, et al. A newly developed spine deformity index (SDI) to quantitate vertebral crush fractures in patients with osteoporosis. Bone Miner 1988 Mar; 3(4): 335–49

    PubMed  CAS  Google Scholar 

  29. Ross PD, Davis JW, Epstein RS, et al. Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med 1991 Jun 1; 114(11): 919–23

    PubMed  CAS  Google Scholar 

  30. Aspray TJ, Prentice A, Cole TJ, et al. Low bone mineral content is common but osteoporotic fractures are rare in elderly rural Gambian women. JBone Miner Res 1996 Jul; 11(7): 1019–25

    Article  CAS  Google Scholar 

  31. Wells G, Cranney A, Shea B, et al. Responsiveness of endpoints in osteoporosis clinical trials. J Rheumatol 1997 Jun; 24(6): 1230–3

    PubMed  CAS  Google Scholar 

  32. Cummings SR, Black DM, Thompson DE, for the FIT Research Group. Alendronate reduces the risk of vertebral fractures in women without pre-existing vertebral fractures: results of the fracture intervention trial [abstract]. J Bone Miner Res 1997 Aug; 12 Suppl. 1: S149

    Google Scholar 

  33. Karpf DB, Shapiro DR, Seeman E, et al. Prevention of non-vertebral fractures by alendronate. A meta-analysis. JAMA 1997 Apr 9; 277(14): 1159–64

    Article  PubMed  CAS  Google Scholar 

  34. Seeley DG, Browner WS, Nevitt MC, et al. Which fractures are associated with low appendicular bone mass in elderly women? Ann Intern Med 1991 Dec 1; 115(11): 837–42

    PubMed  CAS  Google Scholar 

  35. Pols HAP for the FOSIT Study Group. A multinational, placebo-controlled study of alendronate in postmenopausal women with osteoporosis [abstract]. Results from the FOSIT study. J Bone Miner Res 1997 Aug; 12 Suppl. 1: S172

    Google Scholar 

  36. McClung M, Wasnich R, Hosking D, et al. Safety of oral alendronate 5 mg in osteoporosis prevention [abstract]. J Bone Miner Res 1997 Aug; 12 Suppl. 1: S469

    Google Scholar 

  37. Bauer DC, Thompson D, Black DM, et al. Alendronate use is not associated with gastric or duodenal side effects: the fracture intervention trial (FIT) [abstract]. J Bone Miner Res 1997 Aug; 12 Suppl. 1: S468

    Google Scholar 

  38. Maconi G, Porro GB. Multiple ulcerative esophagitis caused by alendronate. Am J Gastroenterol 1995 Oct; 90(10): 1889–90

    PubMed  CAS  Google Scholar 

  39. De Groen PC, Lubbe DF, Hirsch LJ, et al. Esophagitis associated with the use of alendronate. N Engl J Med 1996 Oct 3; 335(14): 1016–21

    Article  PubMed  Google Scholar 

  40. Sorrentino D, Trevisi A, Bernardis V, et al. Esophageal ulceration due to alendronate [letter]. Endoscopy 1996 Aug; 28(6): 529

    Article  PubMed  CAS  Google Scholar 

  41. Rimmer DE, Rawls DE. Improper alendronate administration and a case of pill esophagitis. Am J Gastroenterol 1996 Dec; 91(12): 2648–9

    PubMed  CAS  Google Scholar 

  42. Naylor G, Davies MH. Oesophageal stricture associated with alendronic acid. Lancet 1996 Oct 12; 348(9033): 1030–1

    Article  PubMed  CAS  Google Scholar 

  43. Adami S, Zamberlan N. Adverse effects of bisphosphonates: a comparative review. Drug Saf 1996 Mar; 14(3): 158–70

    Article  PubMed  CAS  Google Scholar 

  44. Blank MA, Ems BL, Gibson GW, et al. Nonclinical model for assessing gastric effects of bisphosphonates. Dig Dis Sci 1997 Feb; 42(2): 281–8

    Article  PubMed  CAS  Google Scholar 

  45. Chapuy MC, Arlot ME, Duboeuf F, et al. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 1992 Dec 3; 327(23): 1637–42

    Article  PubMed  CAS  Google Scholar 

  46. Chapuy MC, Arlot ME, Delmas PD, et al. Effect of calcium and cholecalciferol treatment for three years on hip fractures in elderly women. BMJ 1994 Apr 23; 308(6936): 1081–2

    Article  PubMed  CAS  Google Scholar 

  47. Lips P, Graafmans WC, Ooms ME, et al. Vitamin D supplementation and fracture incidence in elderly persons. A randomized, placebo-controlled clinical trial. Ann Intern Med 1996 Feb 15; 124(4): 400–6

    PubMed  CAS  Google Scholar 

  48. Lindsay R, Hart DM, Aitken JM, et al. Long-term prevention of postmenopausal osteoporosis by oestrogen. Evidence for an increased bone mass after delayed onset of oestrogen treatment. Lancet 1976 May 15; 1(7968): 1038–41

    Article  PubMed  CAS  Google Scholar 

  49. Christiansen C, Christensen MS, Transbol I. Bone mass in postmenopausal women after withdrawal of oestrogen/gestagen replacement therapy. Lancet 1981 Feb 28; 1(8218): 459–61

    Article  PubMed  CAS  Google Scholar 

  50. Wimalawansa SJ. Use of plasma 17 β-estradiol as a guideline for parenteral administration of estrogen for the prevention and treatment of osteoporosis. In: Christiansen C, Overgaard K, editors. Osteoporosis 1990; Handelstrykkeriet, Aalborg: Osteopress ApS, 1990: 1917–22

    Google Scholar 

  51. Hassager C, Jensen SB, Christiansen C. Non-responders to hormone replacement therapy for the prevention of postmenopausal bone loss: do they exist? Osteoporosis Int 1994 Jan; 4(1): 36–41

    Article  CAS  Google Scholar 

  52. Lufkin EG, Wahner HW, O’Fallon WM, et al. Treatment of postmenopausal osteoporosis with transdermal estrogen. Ann Intern Med 1992 Jul 1; 117(1): 1–9

    PubMed  CAS  Google Scholar 

  53. Paganini-Hill A, Ross RK, Gerkins VR, et al. Menopausal estrogen therapy and hip fractures. Ann Intern Med 1981 Jul; 95(1): 28–31

    PubMed  CAS  Google Scholar 

  54. Bush TL. Extraskeletal effects of estrogen and the prevention of atherosclerosis. Osteoporosis Int 1991 Oct; 2(1): 5–11

    Article  CAS  Google Scholar 

  55. Paganini-Hill A, Ross RK, Henderson BE. Postmenopausal oestrogen treatment and stroke: a prospective study. BMJ 1988 Aug 20–27; 297(6647): 519–22

    Article  PubMed  CAS  Google Scholar 

  56. Gangar KF, Vyas S, Whitehead M, et al. Pulsatility index in internal carotid artery in relation to transdermal oestradiol and time since menopause. Lancet 1991 Oct 5; 338(8771): 839–42

    Article  PubMed  CAS  Google Scholar 

  57. Lindsay R, Hart DM, MacLean A, et al. Bone response to termination of oestrogen treatment. Lancet 1978 Jun 24; 1(8078): 1325–7

    Article  PubMed  CAS  Google Scholar 

  58. Devogelaer JP, Triki R, Depresseux G, et al. Remnant effect of Pamidronate on bone metabolism in osteoporosis [abstract]. J Bone Miner Res 1994 Aug; 9 Suppl. 1: S329

    Google Scholar 

  59. Landman JO, Hamdy NAT, Pauwels EKJ, et al. Skeletal metabolism in patients with osteoporosis after discontinuation of long-term treatment with oral Pamidronate [abstract]. Bone 1995 Dec; 17(6): 615

    Article  Google Scholar 

  60. Orr-Walker B, Wattie DJ, Evans MC, et al. Effects of prolonged bisphosphonate therapy and its discontinuation on bone mineral density in postmenopausal osteoporosis. Clin Endocrinol 1997 Jan; 46(1): 87–92

    Article  CAS  Google Scholar 

  61. Stock JL, Bell NH, Chesnut CH III, et al. Increments in bone mineral density of the lumbar spine and hip and suppression of bone turnover are maintained after discontinuation of alendronate in postmenopausal women. Am J Med 1997 Oct; 103: 291–7

    Article  PubMed  CAS  Google Scholar 

  62. Felson DT, Zhang Y, Hannan MT, et al. The effect of postmenopausal estrogen therapy on bone density in elderly women. N Engl J Med 1993 Oct 14; 329(16): 1141–6

    Article  PubMed  CAS  Google Scholar 

  63. Bergkvist L, Adami HO, Persson I, et al. The risk of breast cancer after estrogen and estrogen-progestin replacement. N Engl J Med 1989 Aug 3; 321(5): 293–7

    Article  PubMed  CAS  Google Scholar 

  64. Colditz GA, Hankinson SE, Hunter DJ, et al. The use of estrogens and progestins and the risk of breast cancer in postmenopausal women. N Engl J Med 1995 Jun 15; 332(24): 1589–93

    Article  PubMed  CAS  Google Scholar 

  65. Riggs BL, Hodgson SF, O’Fallon WM, et al. Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis. N Engl J Med 1990 Mar 22; 322(12): 802–9

    Article  PubMed  CAS  Google Scholar 

  66. Nagant de Deuxchaisnes C, Devogelaer JP. Restorative therapy of osteoporosis. In: Broil H, Dambacher MA, editors. Osteoporosis: a guide to diagnosis and treatment. Basel: Karger, 1996, 18: 207–64

    Google Scholar 

  67. Mamelle N, Meunier PJ, Dusan R, et al. Risk-benefit ratio of sodium fluoride treatment in primary vertebral osteoporosis. Lancet 1988 Aug 13; 2(8607): 361–5

    Article  PubMed  CAS  Google Scholar 

  68. Pak CY, Sakhaee K, Adams-Huet B, et al. Treatment of postmenopausal osteoporosis with slow-release sodium fluoride. Final report of a randomized controlled trial. Ann Intern Med 1995 Sep 15; 123(6): 401–8

    PubMed  CAS  Google Scholar 

  69. Watts NB, Harris ST, Genant HK, et al. Intermittent cyclical etidronate treatment of postmenopausal osteoporosis. N Engl J Med 1990 Jul 12; 323(2): 73–9

    Article  PubMed  CAS  Google Scholar 

  70. Harris ST, Watts NB, Jackson RD, et al. Four-year study of intermittent cyclic etidronate treatment of postmenopausal osteoporosis: three years of blinded therapy followed by one year of open therapy. Am J Med 1993 Dec; 95(6): 557–67

    Article  PubMed  CAS  Google Scholar 

  71. Watts NB, Becker P. Alendronate increases bone mineral density at spine and hip in women with postmenopausal osteoporosis who fail to respond to intermittent cyclic etidronate [abstract]. J Bone Miner Res 1997 Aug; 12 Suppl. 1: S171

    Google Scholar 

  72. Rico H, Hernandez ER, Revilla M, et al. Salmon calcitonin reduces vertebral fracture rate in postmenopausal crush fracture syndrome. Bone Miner 1992 Feb; 16(2): 131–8

    Article  PubMed  CAS  Google Scholar 

  73. Overgaard K, Hansen MA, Jensen SB, et al. Effect of salcatonin given intranasally on bone mass and fracture rates in established osteoporosis: a dose-response study. BMJ 1992 Sep 5; 305(6853): 556–61

    Article  PubMed  CAS  Google Scholar 

  74. Stock JL, Avioli LV, Baylink DJ, et al. Calcitonin-salmon nasal spray reduces the incidence of new vertebral fractures in postmenopausal women: three-year interim results of the PROOF study [abstract]. J Bone Miner Res 1997 Aug; 12 Suppl. 1: S149

    Google Scholar 

  75. Tilyard MW, Spears GFS, Thomson J, et al. Treatment of postmenopausal osteoporosis with calcitriol or calcium. N Engl J Med 1992 Feb 6; 326(6): 357–62

    Article  PubMed  CAS  Google Scholar 

  76. Thompson DE, Cummings S, Black D, et al. Clinical (symptomatic) fractures are predictors of all-cause hospitalization [abstract]. J Bone Miner Res 1997 Aug; 12 Suppl. 1: S144

    Google Scholar 

  77. Ensrud KE, Black DM, Palermo L, et al. Treatment with alendronate prevents fractures in women at highest risk. Results from the Fracture Intervention Trial. Arch Intern Med 1997 Dec; 157(22): 2617–24

    Article  PubMed  CAS  Google Scholar 

  78. Vasikaran SD, Khan S, McCloskey EV, et al. Sustained response to intravenous alendronate in postmenopausal osteoporosis. Bone 1995 Dec; 17(6): 517–20

    Article  PubMed  CAS  Google Scholar 

  79. Adami S, Fossaluzza V, Gatti D, et al. Bisphosphonate therapy of reflex sympathetic dystrophy syndrome. Ann Rheum Dis 1997 Mar; 56(3): 201–4

    Article  PubMed  CAS  Google Scholar 

  80. Heaney RP. The bone remodeling transient: implications for the interpretation of clinical studies of bone mass change. J Bone Miner Res 1994 Oct; 9(10): 1515–23

    Article  PubMed  CAS  Google Scholar 

  81. Greenspan SL, Holland S, Maitland-Ramsey L, et al. Alendronate stimulation of nocturnal parathyroid hormone secretion: a mechanism to explain the continued improvement in bone mineral density accompanying alendronate therapy. Proc Assoc Am Phys 1996 May; 108(3): 230–8

    PubMed  CAS  Google Scholar 

  82. Chavassieux PM, Arlot ME, Reda C, et al. Histomorphometric assessment of the long-term effects of alendronate on bone quality and remodeling in patients with osteoporosis. J Clin Invest 1997 Sep; 100(6): 1475–80

    Article  PubMed  CAS  Google Scholar 

  83. Graham DY, Malaty HM, Goodgame R. Primary aminobisphosphonates: a new class of gastrotoxic drugs. Comparison of alendronate and aspirin. Am J Gastroenterol 1997; 92(8): 1322–5

    PubMed  CAS  Google Scholar 

  84. Gold DT. The clinical impact of vertebral fractures: quality of life in women with osteoporosis. Bone 1996 Mar; 18(3) Suppl.: 185S–9S

    Article  PubMed  CAS  Google Scholar 

  85. Hosking D, Chilvers CED, Christiansen C, et al. Prevention of bone loss with alendronate in postmenopausal women under 60 years of age. N Engl J Med 1998 Feb 19; 338(8): 485–92

    Article  PubMed  CAS  Google Scholar 

  86. McClung M, Clemmesen B, Daifotis A, et al. Alendronate prevents bone loss in women without osteoporosis. A double-blind, randomized, controlled trial. Ann Intern Med 1998 Feb 15; 128(4): 253–61

    PubMed  CAS  Google Scholar 

  87. Heaney RP. Bone mass, bone loss, and osteoporosis prophylaxis. Ann Intern Med 1998 Feb 15; 128(4): 313–4

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Rheumatology, Saint-Luc University Hospital, Louvain University in Brussels, Brussels, Belgium

    Jean-Pierre Devogelaer

Authors
  1. Jean-Pierre Devogelaer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jean-Pierre Devogelaer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Devogelaer, JP. A Risk-Benefit Assessment of Alendronate in the Treatment of Involutional Osteoporosis. Drug-Safety 19, 141–154 (1998). https://doi.org/10.2165/00002018-199819020-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002018-199819020-00005

Keywords

Search

Navigation