Letters

Tolerability of alendronate

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7141.1389a (Published 02 May 1998) Cite this as: BMJ 1998;316:1389

Comparison group taking placebo should have been included

  1. Mike Kirby, General practitioner
  1. The Surgery, Nevells Road, Letchworth, Hertfordshire SG6 4TS
  2. Merck Sharp & Dohme, Hoddesdon, Hertfordshire EN11 9BU
  3. Drug Safety Research Unit, Southampton SO31 1AA
  4. Department of Health Care for the Elderly, Belfast City Hospital, Belfast BT9 7AB

    EDITOR—The extent of gastrointestinal side effects attributed by Kelly and Taggart to treatment with alendronate is misleading.1 Their study of 77 patients taking alendronate did not include a comparison group taking placebo, and results have not been adjusted for the underlying prevalence of adverse experiences among the study group. In addition, an appreciable number of their patients had failed to comply with dosing instructions.

    The extent of gastrointestinal disturbances among the elderly general population is high. The fracture intervention trial studied 2027 women with a mean age of 71 and at least one vertebral fracture; it found that 40% of patients taking placebo had an upper gastrointestinal adverse event.2 The number of gastrointestinal events in women taking alendronate was not significantly higher than this.

    I am concerned that exaggerated reports of intolerability of alendronate will lead to reduced prescribing in patients who could gain considerable clinical benefit from this drug. My experience is that careful prescribing in suitable patients, combined with education on compliance, results in minimal problems of intolerance. I will continue to use this drug, which has proved efficacy in preventing fractures, but I agree that compliance with dosing instructions is an important issue and needs to be addressed with every patient taking a bisphosphonate.

    References

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    Manufacturer's comment

    1. John H Young, Medical director
    1. The Surgery, Nevells Road, Letchworth, Hertfordshire SG6 4TS
    2. Merck Sharp & Dohme, Hoddesdon, Hertfordshire EN11 9BU
    3. Drug Safety Research Unit, Southampton SO31 1AA
    4. Department of Health Care for the Elderly, Belfast City Hospital, Belfast BT9 7AB

      EDITOR—Kelly and Taggart present their experience of using alendronate, which Merck Sharp & Dohme manufactures.1 Their experience should …

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