# Osteoporosis (postmenopausal & senile) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: NOGG Osteoporosis Guideline 2021 for the treatment threshold, with the dose from Alendronic Acid 70 mg tablets SmPC section 4.2 (eMC product 5206): "The recommended dosage is one 70 mg tablet once weekly." and "Alendronic Acid should only be swallowed upon arising for the day with a full glass of water (not less than 200 ml). ... Patients should not lie down for at least 30 minutes after taking Alendronic Acid and until after the first food of the day." · NOGG Osteoporosis Guideline 2021 · Egyptian National Drug Formulary - Endocrine System 2024 · Risedronate sodium 35 mg film-coated tablets SmPC sections 4.2 and 4.4 (eMC product 3028) - Verified date: 2026-08 ## Verified against - NOGG Osteoporosis Guideline 2021 for the treatment threshold, with the dose from Alendronic Acid 70 mg tablets SmPC section 4.2 (eMC product 5206): "The recommended dosage is one 70 mg tablet once weekly." and "Alendronic Acid should only be swallowed upon arising for the day with a full glass of water (not less than 200 ml). ... Patients should not lie down for at least 30 minutes after taking Alendronic Acid and until after the first food of the day." - NOGG Osteoporosis Guideline 2021 - Risedronate sodium 35 mg film-coated tablets SmPC sections 4.2 and 4.4 (eMC product 3028) ## Treatment metadata - Alendronate — 70 mg — oral.solid - Risedronate sodium — 35 mg — oral.solid - Calcium carbonate — 500 mg — oral.solid ## Complete treatment card ```text OSTEOPOROSIS (POSTMENOPAUSAL & SENILE) Sources: NOGG Osteoporosis Guideline 2021 for the treatment threshold, with the dose from Alendronic Acid 70 mg tablets SmPC section 4.2 (eMC product 5206): "The recommended dosage is one 70 mg tablet once weekly." and "Alendronic Acid should only be swallowed upon arising for the day with a full glass of water (not less than 200 ml). ... Patients should not lie down for at least 30 minutes after taking Alendronic Acid and until after the first food of the day." · NOGG Osteoporosis Guideline 2021 · Egyptian National Drug Formulary - Endocrine System 2024 · Risedronate sodium 35 mg film-coated tablets SmPC sections 4.2 and 4.4 (eMC product 3028) Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - A prior fragility fracture after menopause roughly doubles later fracture risk, most so in the first two years - Poor libido, infertility, vaginal dryness, or cessation of periods can point to low sex hormones behind the bone loss [infertility · vaginal dryness] - A patient noticing their height has dropped can be a subtle clue to a vertebral fracture SIGNS - what you find (5) - Losing 1.5 inches or more in height calls for spine imaging to check for a vertebral fracture - Progressive vertebral collapse can produce a stooped, hunched spine known as a dowager's hump [collapse] - Being markedly underweight, under about 127 lbs or a BMI under 21, marks a patient at higher risk of low bone density and fracture [underweight] - Nail changes, hair changes, muscle wasting, and dry skin on exam can reveal underlying malnutrition contributing to bone loss [dry skin · muscle wasting · nail changes] - A goiter, tremor, bulging eyes, or fast heart rate suggest hyperthyroidism, while a moon face, fat pad at the back of the neck, and abdominal stretch marks suggest Cushing syndrome [goitre · proptosis · stretch marks · tachycardia · tremor] TESTS (7) - Osteoporosis is defined by a bone density T-score of -2.5 or lower on DEXA scanning of the spine, hip, or forearm - A T-score at or below -2.5 together with one or more fragility fractures is classed as severe osteoporosis - A history of a fragility fracture of the spine or hip is diagnostic of osteoporosis regardless of the bone density result - A Z-score of -2.0 or lower, comparing the patient to others their own age, should trigger a search for a secondary cause - DEXA screening is recommended for all women 65 years and older, no more often than every 1 to 2 years - Baseline labs include a CBC, metabolic panel with calcium and liver enzymes, vitamin D level, and a 24-hour urine calcium collection to check for malabsorption or excess urinary calcium - Bone turnover markers checked at baseline and follow-up can flag rapid bone loss and a higher fracture risk when raised IF NOT THIS - what else fits (9) - Osteopenia, a lesser degree of bone loss, must be distinguished by the T-score - Osteogenesis imperfecta, a genetic bone-fragility disorder, is on the differential - Osteomalacia and vitamin D deficiency, which soften rather than thin the bone, are on the differential - Hyperparathyroidism is on the differential and can be screened for with intact parathyroid hormone - Paget disease of the bone is on the differential - Chronic kidney disease-related bone and mineral disorder is on the differential - Multiple myeloma should be considered and can be screened for with serum protein electrophoresis and free light chains - Metastatic cancer spread to bone is on the differential - Conditions that mimic vertebral osteoporosis on imaging, such as osteoarthritis, scoliosis, or Scheuermann disease, are on the differential Source StatPearls "Osteoporosis in Females" - disease-level clinical article Status traced to the source above 1. ALENDRONATE [1st line] Adult 70 mg once weekly swallowed whole with a full glass of plain water on empty stomach upon arising; remain upright for at least 30 minutes - long-term (5 years, then review) Peds Specialist pediatric metabolic bone clinic use only Choice Alternatives, both oral bisphosphonates. Alendronate carries the larger fracture- prevention evidence base; risedronate is the alternative when upper-gut intolerance is the problem. Source NOGG Osteoporosis Guideline 2021 for the treatment threshold, with the dose from Alendronic Acid 70 mg tablets SmPC section 4.2 (eMC product 5206): "The recommended dosage is one 70 mg tablet once weekly." and "Alendronic Acid should only be swallowed upon arising for the day with a full glass of water (not less than 200 ml). ... Patients should not lie down for at least 30 minutes after taking Alendronic Acid and until after the first food of the day." Why Alendronate is a bisphosphonate that binds bone mineral and inhibits osteoclast-mediated bone resorption, slowing bone loss and increasing bone density; it is standard first- line therapy for postmenopausal and senile osteoporosis per NOGG. Caution STRICT ADMINISTRATION INSTRUCTIONS: Take with plain water only on an empty stomach and stay upright for 30 minutes (severe esophageal ulceration risk if violated). Contraindicated in esophageal abnormalities, inability to sit/stand upright for 30 minutes, or hypocalcemia. Contraindicated if eGFR < 35 mL/min. Atypical femoral fractures and osteonecrosis of the jaw are rare long-term risks; arrange dental exam prior to starting. Egypt ALENDEX 70MG 2 TAB. UNIPHARMA CO.... 17.40 EGP (8.70/unit) OSTEONATE 70MG 4 TAB. ADWIA 40.00 EGP (10.00/unit) BONALENE 70MG 2 TAB. EL-OBOUR 21.60 EGP (10.80/unit) ALENDENE 70MG 2 TAB. ATOS PHARMA 35.00 EGP (17.50/unit) ALENDOMAX 70 MG 2 TABS. SIGMA 35.00 EGP (17.50/unit) OSTEOMEPHA 70MG 2 TAB. SIGMA > ACINO 35.00 EGP (17.50/unit) FOSAMAX ONCE WEEKLY 70MG 2 TAB. MERCK SHARP &... 62.75 EGP (31.38/unit) 2. RISEDRONATE SODIUM [1st line] Adult 35 mg once weekly swallowed whole with plain water on empty stomach 30 minutes before first food/drink; remain upright for 30 minutes - long-term (5 years) Peds Not indicated in children Source Risedronate sodium 35 mg film-coated tablets SmPC sections 4.2 and 4.4 (eMC product 3028) Why Alternative oral bisphosphonate with lower incidence of upper GI intolerance Caution Risedronate sodium has the same strict upper GI administration precautions as alendronate. Contraindicated if eGFR < 30 mL/min or hypocalcemia present. Correct hypocalcemia and vitamin D deficiency before initiating bisphosphonate therapy. A full glass of plain water, at least 120 mL, and stay upright for 30 minutes afterwards. Lying down is how the tablet lodges and burns the oesophagus. Contraindicated below a creatinine clearance of 30 mL/min. Correct low calcium before starting, not during. Arrange a dental check first where there are other risk factors - osteonecrosis of the jaw is the reason. Tell the patient that painful or difficult swallowing, chest pain behind the sternum, or new heartburn means come back, not push through. Egypt ACTOWEEK 35 MG 1 F.C. TAB. CHEMIPHARM 20.00 EGP (20.00/unit) RISALDENE 35MG 2 F.C. TAB. HIKMA PHARMA 40.00 EGP (20.00/unit) 3. CALCIUM CARBONATE [add-on - not a substitute] Adult 500-1000 mg elemental calcium daily combined with Vitamin D3 (Cholecalciferol) 800-1000 IU daily - long-term Peds Pediatric calcium requirements vary by age Source NOGG Osteoporosis Guideline 2021 Why Essential co-prescription with bisphosphonates to maintain bone mineral density and prevent hypocalcemia Caution Separate calcium supplements from bisphosphonates by at least 2 hours (calcium inhibits bisphosphonate absorption). Constipation and flatulence are common. Avoid in hypercalcemia or hypercalciuria. Egypt OSCASEEF 500MG 30 CAPS. SAFE PHARMA 21.75 EGP (0.72/unit) CALCIMATE 500 MG 12 CAPS. EL NASR 20.00 EGP (1.67/unit) CARIBO 500MG 50 CHEW. TABS. AL ESRAA PHAR... 18.00 EGP CALCINEX PLUS SYRUP 120 ML FAMILY PHARMA... 59.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)