title: Comparing tolerability and efficacy of generic versus brand alendronate: a randomized clinical study in postmenopausal women with a recent fracture.
abstract: BACKGROUND
  An increasing number of generic alendronate formulations have become available. Although expected to have the same tolerability and efficacy, head-to head comparison of generic and brand alendronate was never performed. Therefore, we compared the tolerability and efficacy of generic and brand alendronate.
  
  
  METHODS
  In a randomized double-blinded single centre cross-over study in 37 postmenopausal women (mean age 65.4±6.4 years) with osteoporosis were treated with generic and branded alendronate during 24 (2x12) weeks. Tolerance was evaluated by the Gastro intestinal Symptom Rating Scale (GSRS) and self-reported side effects. Efficacy was assessed by serum bone turnover markers, carboxy terminal telopeptide (CTX) and procollagen type I N-terminal propeptide (PINP). No wash out period was allowed (ethical reasons). Because of possible carry over effect only data of the first 12 weeks were analyzed using linear mixed models.
  
  
  RESULTS
  There were no significant differences in overall tolerance (GSRS) between treatment groups. However, for subscale abdominal pain, patients using generic had a significantly higher mean GSRS score at week 4 (estimated mean difference (B): 0.40; 95%CI: 0.05 to 0.74, p = 0.024). The level of bone turnover markers significantly decreased over 12 weeks of follow-up for generic and branded alendronate (p < 0.001). Mean level of CTX was significantly lower with branded at week 4 (B: 121.3; 95%CI: 52.0 to 190.5), but not at week 12 (B: 53.6; 95%CI:-3.7 to 110.9). No significant differences were found for PINP at week 4 or 12.
  
  
  CONCLUSIONS
  Bone turnover markers were significantly reduced with branded and generic alendronate. With branded, CTX was significantly lower at 4 weeks. Generic caused significantly higher abdominal pain scores in the first 4 weeks of treatment. Therefore, generic alendronate may not have the same tolerability and efficacy as branded alendronate in the first weeks after starting treatment in patients with a recent fracture.
  
  
  BACKGROUND
  Dutch Trial Register NTR number 1867 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1867.
authors.affiliation: Department of Internal Medicine, VieCuri Medical Centre of Noord-Limburg, Venlo, The Netherlands ; Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands ; Maastricht University, NUTRIM - School for Nutrition, Toxicology and Metabolism, Maastricht, The Netherlands ; Biomedical Research Centre, University Hasselt, Diepenbeek, Belgium.
authors.forename: Joop P W
authors.initials: JP
authors.lastname: van den Bergh
authors.forename: Marian E
authors.initials: ME
authors.lastname: Bouts
authors.forename: Eveline
authors.initials: E
authors.lastname: van der Veer
authors.forename: Robert Y
authors.initials: RY
authors.lastname: van der Velde
authors.forename: Marcel J W
authors.initials: MJ
authors.lastname: Janssen
authors.forename: Piet P
authors.initials: PP
authors.lastname: Geusens
authors.forename: Bjorn
authors.initials: B
authors.lastname: Winkens
authors.forename: Nico J J
authors.initials: NJ
authors.lastname: Oldenhof
authors.forename: Tineke A C M
authors.initials: TA
authors.lastname: van Geel
mesh_terms: D000368:Aged; D019386:Alendronate / Q000009:adverse effects* / Q000627:therapeutic use*; D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D016568:Drugs, Generic / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D050723:Fractures, Bone / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy
chemical_list: D050071:Bone Density Conservation Agents; D016568:Drugs, Generic; D019386:Alendronate