title: Endoscopic comparison of esophageal and gastroduodenal effects of risedronate and alendronate in postmenopausal women.
abstract: OBJECTIVE
  Bisphosphonates are effective treatment for osteoporosis, but upper gastrointestinal injury associated with some compounds has caused concern. This study compared the incidence of gastric ulcers after treatment with risedronate, a pyridinyl bisphosphonate, and alendronate, a primary amino bisphosphonate. Esophageal and gastroduodenal injury assessed by endoscopy scores was a secondary endpoint.
  
  
  METHODS
  Healthy, postmenopausal women (n = 515) received 5 mg risedronate (n = 255) or 10 mg alendronate (n = 260) for 2 weeks. At baseline and on days 8 and 15, subjects underwent endoscopy and evaluator-blinded assessment of the esophageal, gastric, and duodenal mucosa.
  
  
  RESULTS
  Gastric ulcers were observed during the treatment period in 9 of 221 (4.1%) evaluable subjects in the risedronate group compared with 30 of 227 (13.2%) in the alendronate group (P < 0.001). Mean gastric endoscopy scores for the risedronate group were lower than those for the alendronate group at days 8 and 15 (P </= 0.001). Mean esophageal and duodenal endoscopy scores were similar in the 2 groups at days 8 and 15. Esophageal ulcers were noted in 3 evaluable subjects in the alendronate group, compared with none in the risedronate group, and duodenal ulcers were noted in 1 evaluable subject in the alendronate group and 2 in the risedronate group.
  
  
  CONCLUSIONS
  At doses used for the treatment of osteoporosis, risedronate was associated with a significantly lower incidence of gastric ulcers than alendronate. These findings confirm that bisphosphonates differ in their potential to damage the gastroesophageal mucosa.
authors.affiliation: Houston Institute for Clinical Research, Houston, Texas 77074, USA. dr.lanza@pdq.net
authors.forename: F L
authors.initials: FL
authors.lastname: Lanza
authors.forename: R H
authors.initials: RH
authors.lastname: Hunt
authors.forename: A B
authors.initials: AB
authors.lastname: Thomson
authors.forename: J M
authors.initials: JM
authors.lastname: Provenza
authors.forename: M A
authors.initials: MA
authors.lastname: Blank
mesh_terms: D000328:Adult; D019386:Alendronate / Q000009:adverse effects*; D004384:Duodenoscopy; D004386:Duodenum / Q000187:drug effects* / Q000473:pathology; D004724:Endoscopy; D004945:Esophagoscopy; D004947:Esophagus / Q000187:drug effects* / Q000473:pathology; D012968:Etidronic Acid / Q000009:adverse effects* / Q000031:analogs & derivatives*; D005260:Female; D005773:Gastroscopy; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy*; D000068296:Risedronic Acid; D016037:Single-Blind Method; D013270:Stomach / Q000187:drug effects* / Q000473:pathology; D013276:Stomach Ulcer / Q000139:chemically induced / Q000453:epidemiology
chemical_list: D000068296:Risedronic Acid; D012968:Etidronic Acid; D019386:Alendronate