Comprehensive Guide to Bisphosphonate Therapy
Available treatment options
When it comes to bisphosphonates, we have several oral options. Alendronic acid is usually the first-line choice on the NHS due to cost-effectiveness. However, I frequently prescribe Actonel (which contains the active ingredient risedronate sodium ) through independent platforms for patients who need an alternative.
Actonel comes in daily, weekly, or monthly doses. From my clinical experience, while alendronic acid works wonderfully for many, I often recommend Actonel for patients who struggle with the strict fasting and upright-posture rules of standard bisphosphonates, as risedronate can sometimes be better tolerated in the stomach and offers flexible dosing schedules that better fit a busy lifestyle.
What to expect from treatment
Starting a bisphosphonate requires a strict routine—taking it on an empty stomach with a full glass of water and staying upright for at least 30 minutes. Patients often ask me how they will know if the medication is working, since they cannot 'feel' their bones getting stronger.
I always tell them that in osteoporosis treatment, 'no news is good news.' The absence of new fractures is our primary goal. We typically will not repeat a bone density scan for at least two to three years, as bone turnover is a remarkably slow process.
Do not be discouraged if your next scan only shows 'stable' bone density rather than a massive increase; stopping the decline is a huge medical victory.
Self-care and prevention
Medication is only half the battle. Your bones need raw materials to rebuild, which means adequate dietary calcium and Vitamin D. But beyond diet, exercise is paramount. A common misconception I correct in my clinic is the type of exercise needed.
Swimming and cycling are fantastic for your heart, but they do almost nothing for your bone density because the water or the bicycle supports your body weight. To build bone, you need gravity and impact.
I advise my patients to engage in brisk walking, dancing, or light weightlifting—activities where your bones have to physically resist the pull of the earth. This mechanical stress is what signals your body to send calcium to the bones.

