Intended for healthcare professionals

Letters Bisphosphonates for osteoporosis

Authors’ reply to Minisola and colleagues, Kausar, and Sharvill

BMJ 2015; 351 doi: (Published 04 November 2015) Cite this as: BMJ 2015;351:h5873
  1. Kurt A Kennel, assistant professor of medicine1,
  2. Spyridoula Maraka, instructor in medicine1
  1. 1Division of Endocrinology, Diabetes, Nutrition, and Metabolism, Mayo Clinic, Rochester, MN 55905, USA
  1. kennel.kurt{at}

We appreciate Minisola and colleagues’ comments and confirm that bisphosphonates may be considered in patients with monoclonal gammopathy of undetermined significance, which affects bone health.1 2

An oral solution of alendronate sodium is available in the US in a 70 mg/75 mL formulation. We were unaware of the alendronic acid solution 70 mg/100 mL available in the UK. We could find no comparisons of the tolerability of these products with other oral bisphosphonate formulations but note the high prevalence of baseline gastrointestinal problems in those who might be prescribed bisphosphonates.3

We wrote “Before starting bisphosphonates it is necessary to assess for and correct hypocalcemia and vitamin D deficiency” with Bertoldo and colleagues’ data in mind but appreciate the additional attention Minisola and colleagues bring to this matter.4

These respondents allude to “treatment failure” and …

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