From the Guidelines
Alendronate is typically prescribed at 70 mg once weekly for treating osteoporosis in adults, as supported by the most recent evidence from 1. For prevention of osteoporosis, a lower dose of 35 mg once weekly or 5 mg daily is often used. The dosage of alendronate can be summarized as follows:
- 70 mg once weekly for treatment of osteoporosis
- 35 mg once weekly or 5 mg daily for prevention of osteoporosis Alendronate should be taken first thing in the morning with a full glass of plain water (6-8 ounces), at least 30 minutes before consuming any food, beverages, or other medications. Patients must remain upright (sitting or standing) for at least 30 minutes after taking the medication to prevent esophageal irritation. This bisphosphonate works by inhibiting osteoclast activity, thereby reducing bone resorption and increasing bone mineral density. Adequate calcium (1000-1200 mg daily) and vitamin D (800-1000 IU daily) supplementation should accompany alendronate therapy for optimal effectiveness, as noted in 1. Treatment duration varies based on fracture risk, but is typically reassessed after 3-5 years of continuous use to evaluate the need for continued therapy. The evidence from 1 also supports the use of alendronate in reducing the risk of vertebral fractures. Key points to consider when prescribing alendronate include:
- Dosage: 70 mg once weekly for treatment, 35 mg once weekly or 5 mg daily for prevention
- Administration: first thing in the morning with plain water, remaining upright for at least 30 minutes
- Supplementation: adequate calcium and vitamin D
- Treatment duration: reassessed after 3-5 years of continuous use.
From the FDA Drug Label
The efficacy of alendronate sodium 10 mg daily was assessed in four clinical trials. The therapeutic equivalence of once weekly alendronate sodium 35 mg (n=362) and alendronate sodium 5 mg daily (n=361) was demonstrated in a one-year, double-blind, multicenter study of postmenopausal women without osteoporosis. A two-year, double-blind, placebo-controlled, multicenter study of alendronate sodium 10 mg once daily enrolled a total of 241 men between the ages of 31 and 87 (mean, 63) A one-year, double-blind, placebo-controlled, multicenter study of once weekly alendronate sodium 70 mg enrolled a total of 167 men between the ages of 38 and 91 (mean, 66) The efficacy of alendronate sodium 5 and 10 mg once daily in men and women receiving glucocorticoids (at least 7. 5 mg/day of prednisone or equivalent) was demonstrated in two, one-year, double-blind, randomized, placebo-controlled, multicenter studies
The recommended dose of alendronate is:
- 10 mg daily for the treatment of osteoporosis in postmenopausal women and men
- 5 mg daily for the prevention of osteoporosis in postmenopausal women
- 35 mg once weekly for the treatment of osteoporosis in postmenopausal women
- 70 mg once weekly for the treatment of osteoporosis in men
- 5 mg daily and 10 mg daily for the treatment of glucocorticoid-induced osteoporosis in men and women 2, 2
From the Research
Alendronate Dosing
- The standard dose of alendronate for the treatment of osteoporosis is 10 mg/day or 70 mg once weekly 3, 4, 5.
- Studies have shown that once-weekly dosing with alendronate 70 mg is therapeutically equivalent to daily dosing with alendronate 10 mg 4, 5.
- Alendronate 70 mg once weekly has been found to be as effective as alendronate 10 mg daily in increasing bone mineral density and reducing the risk of fractures 3, 5.
- Patient preference studies have shown that patients prefer once-weekly dosing with alendronate 70 mg over once-daily dosing with alendronate 10 mg due to its convenience and potential for improved compliance 6.
Alternative Dosing Regimens
- Alendronate 35 mg twice weekly has also been found to be effective in increasing bone mineral density and reducing the risk of fractures 5.
- A study found that remission can be achieved with once-weekly, "osteoporosis doses" of alendronate or risedronate in a large proportion of "real world" Paget's disease of bone patients 7.