Risedronate with calcium carbonate and colecalciferol

How it works

Risedronate inhibits osteoclast-mediated bone resorption, while calcium and colecalciferol correct or prevent deficiency to support adequate substrate and calcium homeostasis for bone mineralisation.

Prescribing in practice

• Risedronate and the calcium-containing tablets must never be taken together, because calcium binds the bisphosphonate and abolishes its absorption; follow the calendar pack sequence exactly.
• Take risedronate on an empty stomach with plain water while sitting or standing upright, remaining upright afterwards to reduce oesophageal irritation and ulceration.
• Ensure adequate renal function and correct hypocalcaemia before starting; counsel on the rare risks of osteonecrosis of the jaw and atypical femoral fracture with prolonged use.

Monitoring

Monitor renal function and serum calcium, maintain dental health, and periodically review the continued need for bisphosphonate therapy.

Counselling the patient

• Follow the pack week by week and never take the risedronate tablet and the calcium tablets on the same day.
• Swallow risedronate whole with a full glass of water and stay sitting or standing for at least half an hour.
• Report any new thigh or groin pain, or dental problems, to your team.

Evidence & guidelines

Bisphosphonates reduce osteoporotic fracture risk, and combining with calcium and vitamin D reflects standard practice of ensuring adequate calcium and vitamin D status during antiresorptive therapy.