Alendronic acid: new preparation. Limited efficacy, risk of oesophagitis

After 3 years of alendronic acid treatment in post-menopausal women with a history of vertebral fracture, a large clinical trial has shown a reduction in the incidence of vertebral, hip and wrist fractures with clinical repercussions. As regards vertebral fractures with clinical repercussions, 1 000 osteoporotic women would have to be treated for three years to avoid 27 fractures. Alendronic acid has not been compared with etidronate, but, in our opinion, it has better evidence for its efficacy. Treatment can be offered only to women with a history of osteoporotic fractures who strictly follow the necessary precautions. The tablets must be taken in the morning on an empty stomach, with a large glass of water while seated upright or standing, and avoiding lying down for at least thirty minutes after. These precautions reduce the risk of oesophagitis and oesophageal ulceration. Pending the results of an ongoing trial of alendronic acid in this setting, hormone replacement therapy is the only treatment warranted in women with no history of osteoporotic fracture.