Fosamax (alendronate sodium) is a first-line bisphosphonate medication specifically formulated for the treatment and prevention of 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 and promoting a positive bone mineral balance. This oral tablet is a cornerstone of pharmacological management for skeletal disorders characterized by low bone mass and microarchitectural deterioration.

Features

• Active pharmaceutical ingredient: Alendronate sodium
• Drug class: Nitrogen-containing bisphosphonate
• Administration: Oral tablet
• Available in weekly (70 mg) and daily (5 mg, 10 mg, 35 mg, 40 mg) dosing regimens
• Designed for optimal bioavailability on an empty stomach

Benefits

• Significantly reduces the risk of vertebral, hip, and wrist fractures.
• Increases bone mineral density (BMD) at the lumbar spine and femoral neck.
• Modulates bone remodeling by suppressing excessive bone turnover.
• Provides a convenient once-weekly dosing schedule for long-term management.
• Offers a well-established safety and efficacy profile from extensive clinical trials.

Common use

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

Dosage and direction

For the treatment of osteoporosis in postmenopausal women and to increase bone mass in men with osteoporosis, the recommended dosage is one 70 mg tablet once weekly or one 10 mg tablet once daily.

For the prevention of osteoporosis in postmenopausal women, the recommended dosage is one 35 mg tablet once weekly or one 5 mg tablet once daily.

For the treatment of glucocorticoid-induced osteoporosis, the recommended dosage is one 5 mg tablet once daily. For postmenopausal women not receiving estrogen, the recommended dosage is one 10 mg tablet once daily.

For the treatment of Paget’s disease of bone, the recommended treatment regimen is 40 mg once daily for six months.

Crucial Administration Instructions:

• Take immediately upon rising for the day, at least 30 minutes before the first food, beverage, or other medication of the day.
• Swallow the tablet whole with a full glass (6-8 oz) of plain water only. Do not use mineral water, coffee, tea, juice, or milk.
• Remain in an upright position (sitting or standing) for at least 30 minutes after taking the tablet and until after the first food of the day. Do not lie down.
• This is essential to facilitate rapid esophageal passage and minimize the potential for esophageal irritation and ulceration.

Precautions

• Fosamax is contraindicated in patients with abnormalities of the esophagus which delay emptying, such as stricture or achalasia.
• Use with caution in patients with active upper gastrointestinal (GI) problems, such as dysphagia, esophageal disease, gastritis, duodenitis, or ulcers.
• Instruct patients on the proper administration method to avoid esophageal adverse events.
• Hypocalcemia must be corrected before initiating therapy. Ensure adequate intake of calcium and vitamin D.
• May cause local irritation of the upper gastrointestinal mucosa. Discontinue use if new or worsening symptoms occur.
• 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 prior to treatment.
• 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.
• Not recommended for patients with severe renal impairment (creatinine clearance <35 mL/min).

Contraindications

• Hypersensitivity to alendronate sodium or any constituent of the formulation.
• Esophageal abnormalities that delay emptying (e.g., stricture, achalasia).
• Inability to stand or sit upright for at least 30 minutes.
• Patients at increased risk of aspiration.
• Hypocalcemia.

Possible side effect

Common side effects may include:

• Abdominal pain
• Dyspepsia
• Acid regurgitation
• Constipation
• Diarrhea
• Flatulence
• Musculoskeletal pain (bone, muscle, or joint pain)
• Headache

Serious side effects require immediate medical attention. These include:

• Severe heartburn, pain upon swallowing, or difficulty swallowing (dysphagia)
• Chest pain
• New or worsening heartburn
• Jaw pain, numbness, swelling, or loose teeth (symptoms of osteonecrosis)
• Unusual thigh or groin pain (may indicate an atypical femoral fracture)
• Eye pain, inflammation, or vision changes

Drug interaction

• Calcium Supplements, Antacids, and Mineral Supplements: Significantly interfere with the absorption of Fosamax. Administer these products at a different time of day (at least 30 minutes after Fosamax or later).
• Aspirin and NSAIDs: Concomitant use may increase the risk of upper gastrointestinal adverse reactions.
• Other Oral Medications: Since Fosamax requires administration with only plain water and requires a fasting state, the absorption of other orally administered drugs may be affected if taken concurrently.

Missed dose

If a once-weekly dose is missed, instruct the patient to take one tablet on the morning after they remember. They should not take two tablets on the same day. The patient should then return to taking one tablet once a week, as originally scheduled on their chosen day.

For a daily dose, if a dose is missed, it should be skipped for that day. The patient should not take it later in the day. The next dose should be taken the following morning as scheduled.

Overdose

Hypocalcemia, hypophosphatemia, and upper gastrointestinal adverse events, such as upset stomach, heartburn, esophagitis, gastritis, or ulcer, may occur. Milk or antacids should be given to bind alendronate. The patient should remain fully upright. Due to the risk of esophageal irritation, vomiting should not be induced. Medical attention should be sought immediately. Dialysis would not be beneficial.

Storage

• Store at room temperature, 20°C to 25°C (68°F to 77°F), in a dry place.
• Keep in the original container with the desiccant canister to protect from moisture.
• Keep out of reach of children and pets.

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 confirmed osteoporosis, my endocrinologist prescribed weekly Fosamax. Two years into treatment, my follow-up scan showed a significant 8% increase in lumbar spine BMD. The dosing instructions are strict but manageable once they become part of your routine.” – Linda R., 68

“As a clinician, I have prescribed Fosamax for over a decade. Its efficacy in fracture risk reduction is robust and well-documented in the literature. The key to success and tolerability is meticulous patient education on the administration protocol to minimize GI discomfort.” – Dr. Evan S., Rheumatologist

“I was initially concerned about side effects, but my doctor thoroughly explained the benefits versus risks. I’ve been on the 70mg weekly dose for 18 months with no issues. I take it first thing every Sunday morning and have experienced no gastrointestinal problems by strictly following the instructions.” – Robert T., 71