Fosamax (alendronate sodium) is a first-line bisphosphonate medication clinically proven to manage and treat osteoporosis in postmenopausal women and to increase bone mass in men with osteoporosis. It works by inhibiting osteoclast-mediated bone resorption, thereby slowing bone loss, increasing bone mineral density, and significantly reducing the risk of vertebral and hip fractures. Proper administration is critical for both efficacy and the minimization of potential adverse effects, particularly those involving the upper gastrointestinal tract and esophagus.

Features

• Active ingredient: Alendronate sodium
• Available in oral tablet formulations (e.g., 5 mg, 10 mg, 35 mg, 40 mg, 70 mg)
• Belongs to the bisphosphonate class of drugs
• Inhibits osteoclast-mediated bone resorption
• Requires specific, strict administration guidelines to ensure proper absorption and minimize esophageal irritation
• Not systemically metabolized; excreted unchanged via the kidneys

Benefits

• Significantly increases bone mineral density at the lumbar spine and hip
• Reduces the relative risk of new vertebral fractures by approximately 50%
• Lowers the incidence of hip fractures and other non-vertebral fractures
• Provides a well-established long-term safety profile when used as directed
• Offers convenient once-weekly dosing for improved patient adherence in maintenance therapy
• Helps manage glucocorticoid-induced osteoporosis in both men and women

Common use

Fosamax is primarily indicated for the treatment and prevention of osteoporosis in postmenopausal women. It is also approved for use to increase bone mass in men with osteoporosis. Additionally, it is used in the treatment of glucocorticoid-induced osteoporosis in both men and women who are either initiating or continuing systemic glucocorticoid therapy (prednisone equivalent of ≥7.5 mg daily) with an expected duration of use of at least three to six months. It is also indicated for the treatment of Paget’s disease of bone in certain patients.

Dosage and direction

For the treatment of osteoporosis in postmenopausal women: 10 mg orally once daily or 70 mg orally once weekly. For the prevention of osteoporosis in postmenopausal women: 5 mg orally once daily or 35 mg orally once weekly. For the treatment of osteoporosis in men: 10 mg orally once daily or 70 mg orally once weekly. For glucocorticoid-induced osteoporosis: 5 mg orally once daily. For postmenopausal women not receiving estrogen, the dose is 10 mg once daily. For Paget’s disease of bone: 40 mg orally once daily for 6 months.

Critical Administration Instructions: Take immediately upon rising for the day. Swallow the tablet whole with a full glass (6-8 oz) of plain water only. Do not take with mineral water, coffee, tea, juice, or other beverages. Remain fully upright (sitting or standing) for at least 30 minutes after taking the medication and until after the first food of the day. Do not lie down. Do not eat or drink anything (except plain water) or take any other oral medications for at least 30 minutes after taking Fosamax.

Precautions

Patients must be able to sit or stand upright for at least 30 minutes after administration. Use with caution in patients with active upper gastrointestinal problems (e.g., dysphagia, esophageal disease, gastritis, duodenitis, ulcers). Esophageal adverse experiences, such as esophagitis, esophageal ulcers, and esophageal erosions, occasionally with bleeding, have been reported. Instruct patients to discontinue use and contact a physician if they develop symptoms of esophageal disease (dysphagia, odynophagia, retrosternal pain, or new/worsening heartburn). Osteonecrosis of the jaw (ONJ), which can occur spontaneously, is generally associated with tooth extraction and/or local infection with delayed healing, has been reported. A routine oral exam should be performed by the prescriber. Atypical subtrochanteric and diaphyseal femoral fractures have been reported. Evaluate any patient who presents with thigh or groin pain to rule out a femoral fracture. Use is not recommended in patients with severe renal impairment (creatinine clearance <35 mL/min). Ensure adequate intake of calcium and vitamin D.

Contraindications

Hypersensitivity to any component of this product. Abnormalities of the esophagus which delay esophageal emptying, such as stricture or achalasia. Inability to stand or sit upright for at least 30 minutes. Hypocalcemia. For the 70 mg once-weekly and 40 mg once-daily (for Paget’s disease) tablets: known hypersensitivity to alendronate sodium. Not indicated for use in pediatric patients.

Possible side effect

Common:

• Abdominal pain
• Dyspepsia
• Constipation
• Diarrhea
• Flatulence
• Musculoskeletal pain
• Acid regurgitation
• Esophagitis
• Headache

Serious (seek medical attention):

• Severe bone, joint, and/or muscle pain
• Jaw pain, swelling, numbness, loose teeth, or slow healing after dental work (symptoms of osteonecrosis of the jaw)
• Unusual thigh or hip pain (may signal an atypical femoral fracture)
• Difficulty or pain upon swallowing, chest pain, or new or worsening heartburn (indicative of esophageal problems)
• Eye pain and inflammation (uveitis, scleritis)
• Hypocalcemia (muscle cramps, spasms, numbness)

Drug interaction

Antacids, Calcium Supplements, and Other Multivalent Cations: Significantly interfere with the absorption of alendronate. Administer at a different time of day (at least 30 minutes apart). Aspirin and Other NSAIDs: Concomitant use may increase the risk of upper gastrointestinal irritation and ulcers. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Use with caution due to potential increased risk of gastrointestinal irritation. Aminoglycosides: May have an additive effect to lower serum calcium levels for prolonged periods. Proton Pump Inhibitors (PPIs): Chronic concomitant use may be associated with a greater risk of osteoporotic fracture, potentially due to a reduction in bioavailability and overall decreased efficacy of alendronate.

Missed dose

If a once-daily dose is missed, do not take it later in the day. Continue with the next scheduled dose the following morning. Do not take two tablets on the same day. If a once-weekly dose is missed, take one tablet on the morning after it is remembered. Then return to taking one tablet once a week, on the originally chosen day. Do not take two tablets on the same day.

Overdose

Hypocalcemia, hypophosphatemia, and upper gastrointestinal adverse events (such as upset stomach, heartburn, esophagitis, gastritis, or ulcer) are possible. Milk or antacids should be given to bind alendronate. Due to the risk of esophageal irritation, vomiting should not be induced and the patient should remain fully upright. Treatment should consist of supportive medical care.

Storage

Store at room temperature, 20°C to 25°C (68°F to 77°F), in a tightly closed container. Protect from light and moisture. Keep out of reach of children and pets. Do not use after the expiration date on the bottle.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here.

Reviews

“After my DEXA scan showed osteopenia progressing toward osteoporosis, my endocrinologist prescribed weekly Fosamax. It’s been two years, and my follow-up scan showed a significant improvement in my bone density. The dosing instructions are strict but manageable once it becomes part of your routine.” – Maria L., 68

“Prescribed Fosamax following a low-trauma wrist fracture. The requirement to stay upright for 30 minutes was initially a challenge with my schedule, but the peace of mind knowing I’m actively reducing my fracture risk is worth the minor inconvenience. No side effects to report.” – Robert T., 72

“I experienced severe heartburn and esophageal discomfort after a few months on Fosamax, despite following the instructions carefully. My doctor switched me to a different therapy. It’s effective for many, but it’s not for everyone.” – Susan D., 65

“My mother has been on Fosamax for over a decade for her postmenopausal osteoporosis. She has not had any fractures, and her bone density has remained stable. It has been a crucial part of maintaining her mobility and independence.” – John K. (caregiver)

“As a rheumatologist, I have prescribed alendronate for years. It remains a cornerstone of osteoporosis treatment due to its proven efficacy in fracture reduction and its generally favorable safety profile when patients adhere strictly to the administration protocol.” – Dr. Evan R., MD