Currently in Canada there are two bisphosphonates available - etidronate and alendronate. Of the two, alendronate is much more potent and so works faster to build bone mass. Studies have shown that both drugs reduce the risk of vertebral fracture. Of the two agents etidronate is considerably less expensive. It is taken in the morning on an empty stomach and with water.
Calcium supplementation is taken later in the day.
Because of the risk of esophageal erosion with reflux, patients are instructed not to lie down for half an hour after taking the medication. The FIT trial did not find a higher incidence of GI upset in the alendronate group as compared to the placebo group. Therapy is continued for 5 to 7 years and there is evidence that the beneficial effect continues to work for some time after discontinuation of the drug. For patients embarking on a course of long term steroids, don't forget the potential for osteoporosis, and consider starting a bisphosphonate with the steroid. Testosterone therapy in glucocorticoid-treated men.