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How Does Risedronate Increase Bone Density?

Written by Juhi Modi
Medically reviewed by HaVy Ngo-Hamilton, Pharm.D. | Updated Sep 26, 2023

How Does Risedronate Increase Bone Density

Bone turnover is the process by which old bone is broken down and replaced by new bone. Osteoporosis is a bone disease in which bone formation does not keep up with bone loss. This results in low bone mineral density (BMD) and low bone mass, which causes a decrease in bone strength and an increase in fracture risk.

Osteoporosis can affect people of all ages and genders, but Asian and Caucasian postmenopausal women are at the highest risk. Lifestyle changes such as a healthy diet, weight-bearing exercise, and medications are used to treat osteoporosis.

Risedronate is one of the medications used to treat postmenopausal osteoporosis by increasing bone density and decreasing bone breakdown. Please continue reading to find out how it works.

What is risedronate?

Risedronate (brand names: Actonel, Atelvia) belongs to a group of drugs called bisphosphonates. These drugs are taken by mouth or injection. Examples of oral bisphosphonates include risedronate (Actonel, Atelvia), alendronate (Fosamax), and ibandronate (Boniva). Intravenous bisphosphonates include zoledronic acid (Zometa, Reclast) and pamidronate (Aredia).

Which bisphosphonate is right for me?

Your healthcare provider will help you choose the best bisphosphonate for you based on your history of fractures, kidney function, and your response to initial medications such as Vitamin D and Calcium. Some bisphosphonates are taken as a weekly pill (risedronate and alendronate therapy), some as a monthly pill (risedronate, ibandronate), some as a quarterly intravenous infusion (ibandronate), and some as an annual IV infusion (zoledronic acid).

What conditions are bisphosphonate used to treat?

One condition that bisphosphonates are used to treat is established postmenopausal osteoporosis. They can also prevent osteoporosis in the early postmenopausal population. Postmenopausal women with osteoporosis are at an increased risk of vertebral and nonvertebral fractures due to poor bone quality. Risedronate and other bisphosphonates help to increase bone mineral density and lower fracture risk by their effects on bone metabolism.

Bisphosphonates are also prescribed to men with osteoporosis and to people with certain medical conditions such as corticosteroid-induced osteoporosis, Paget’s disease of bone, hypercalcemia of malignancy (high calcium levels in cancer patients), metastatic cancer, and multiple myeloma. Off-label uses include the treatment of osteogenesis imperfecta (a genetic condition characterized by weak bones) and other medical conditions in which there are multiple risk factors for bone fractures.

What does risedronate do to your bones?

Risedronate slows down bone resorption (breakdown) by osteoclasts. It helps bone formation keep up with bone loss, thereby increasing bone mineral density. This effect on bone turnover helps to lower the risk of a fragility fracture due to weak bones.

How do you know a bisphosphonate is working?

The clinical efficacy of bisphosphonates cannot be measured directly in clinical practice. However, a measure of bone density and a reduction in bone markers from bone resorption after starting bisphosphonate therapy can be used as a reasonably reliable indicator of bone mineralization and bisphosphonate effectiveness. (Bone turnover markers are proteins that are released during bone remodeling by osteoblasts and osteoclasts).

How quickly does risedronate work?

The maximum suppression of bone resorption occurs roughly 3 months after starting oral bisphosphonate therapy and remains constant with continuing treatment. Suppression of bone resorption occurs more rapidly after administration of intravenous (IV) bisphosphonates compared to oral bisphosphonate therapy.

Does risedronate reverse osteoporosis?

There is no evidence that risedronate reverses bone loss. However, by slowing down the bone loss portion of the bone turnover cycle, new bone formation is allowed to catch up with bone resorption, thereby increasing bone mineral density and treating osteoporosis.

How long should you take risedronate for osteoporosis?

You should take risedronate for osteoporosis for as long as your doctor advises. Risedronate can help control osteoporosis, but it will not cure the condition. It treats and prevents osteoporosis only when you take it regularly.

Continue risedronate even if you haven’t had any new vertebral fractures, hip fractures, wrist fractures, or atypical fractures. Do not stop treatment without talking to your healthcare provider. However, check with your provider periodically during prolonged bisphosphonate therapy to find out if you still need to continue on this medicine, depending on the original cause of your condition.

Postmenopausal women with osteoporosis are usually assessed for bone fracture risk after several years of bisphosphonate therapy. This assessment typically includes a bone mineral density (BMD) test.

If you are on risedronate for corticosteroid-induced bone loss, you will likely take it for as long as you are on steroid medicines.

Should I take calcium with risedronate?

You should not eat, drink, or lie flat for at least 30 minutes after your risedronate dose. However, it is important to eat a balanced and healthy diet with adequate calcium and vitamin D intake (for example, dairy products and fortified foods) at other times of the day.

Your doctor may prescribe Actonel with Calcium. This is a packaged product that contains Actonel (risedronate sodium tablet 35 mg) to be taken once a week and six calcium carbonate tablets (1250 mg with 500 mg equivalent of elemental calcium) to be taken daily on the remaining six days of the week. Each Actonel with Calcium package contains a 28-day course of therapy.

How effective is risedronate in lowering osteoporotic fracture risk?

Clinical trials have shown risedronate is a safe and effective treatment for osteoporosis. A randomized controlled trial (placebo-controlled study) enrolled postmenopausal women below 85 years of age who had a history of vertebral fracture incidence at baseline.

The results showed a statistically significant difference (vertebral efficacy) with risedronate therapy. The randomized trial found that postmenopausal women had a decrease in new vertebral fractures by 41% compared to the placebo group. Bone mineral density was significantly higher in the treatment group at all high-risk sites for osteoporotic fractures (femoral neck BMD (hip), lumbar spine, and wrist).

The conclusion of the study was that risedronate is a safe and effective treatment for osteoporosis.

Who should not take risedronate?

People who have had an allergic reaction to risedronate in the past should not take this medication. Also, tell your doctor and pharmacist if you are allergic to any other bisphosphonate or other medications.

Drug interactions between risedronate and your other medications can lead to serious adverse events. Give your doctor and pharmacist a complete list of your medications, including prescription drugs, nonprescription medications, nutritional supplements, and herbal remedies. Your provider may change the dose of your medications, choose different medications, and/or monitor you carefully for adverse effects.

People who have a history of certain medical conditions may not be good candidates for risedronate treatment. Tell your healthcare provider if you have low calcium levels, heartburn, difficulty swallowing, any conditions affecting the gastrointestinal tract (including the esophagus), stomach ulcers, anemia, infections, blood clotting disorders, dental conditions, renal impairment (kidney disease), an inability to stand or sit upright, breast cancer, prostate cancer, or a history of radiation therapy.

Risedronate is the active ingredient in both Actonel and Atelvia. If you are taking one of these, do not take the other at the same time.

Follow your provider’s instructions carefully on how to take risedronate correctly (on an empty stomach first thing in the morning). Take other oral medications, including antacids, vitamins, and supplements, after at least 30 minutes have passed from your last risedronate dose.

Inform your doctor if you are pregnant, could be pregnant, or are planning a pregnancy in the near future. Call your doctor without delay if you become pregnant while taking risedronate. Also, tell your provider if you are breastfeeding.

Tell your doctor right away if you develop pain in your muscles, joints, or bones while on risedronate. The pain can develop within days, several months later, or even years after starting risedronate. It usually goes away when you stop the medication.

Risedronate can increase your risk of developing a serious complication of the jaw bone called osteonecrosis. Make an appointment to see your dentist for cleaning of your teeth and fixing of ill-fitting dentures, etc., before starting osteoporosis treatment with risedronate. Brush your teeth regularly while on this medication. Tell your dentist you are taking risedronate before any dental treatment.

Patients treated with risedronate should also talk to their healthcare professional about other measures to increase bone mineral density, such as avoiding smoking and excessive alcohol consumption and getting regular weight-bearing exercise.

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