From the Guidelines
Fosamax (alendronate) can be taken with a current pathologic fracture, as it may help in the healing process by reducing bone resorption and increasing bone density, but the decision should be made by a healthcare provider based on individual circumstances. According to the most recent guideline from the American College of Rheumatology 1, bisphosphonates, such as alendronate, are recommended for the treatment of osteoporosis in adults at moderate, high, or very high risk of fracture. The standard dose of alendronate is typically 70 mg once weekly or 10 mg daily, taken with a full glass of water at least 30 minutes before the first food or drink of the day. Patients must remain upright for at least 30 minutes after taking the medication to prevent esophageal irritation.
While taking alendronate, adequate calcium (1000-1200 mg daily) and vitamin D (800-1000 IU daily) supplementation is important to support bone healing, as recommended by the evidence-based guideline for the management of osteoporosis in men 1. The medication may be particularly beneficial in cases where the pathologic fracture is due to underlying bone weakness, as it can help prevent future fractures. However, in some specific situations, such as certain jaw-related pathologic fractures or atypical femur fractures potentially associated with long-term bisphosphonate use, alendronate might be contraindicated.
Some key points to consider when taking alendronate with a current pathologic fracture include:
- Monitoring of bone turnover markers to assess adherence to therapy, as recommended by the guideline 1
- Regular follow-up with a healthcare provider to assess fracture risk and adjust treatment as needed
- Pain management and appropriate immobilization or surgical intervention for the fracture should be addressed concurrently with any medication regimen
- The potential benefits and harms of alendronate should be carefully weighed, considering the individual's overall health and fracture risk.
It is essential to note that the decision to take alendronate with a current pathologic fracture should be made in consultation with a healthcare provider, taking into account the individual's specific circumstances and medical history.
From the Research
Fosamax and Pathologic Fracture
- Fosamax, also known as alendronate, is a bisphosphonate used to treat osteoporosis and prevent fractures.
- The question of whether Fosamax can be taken with a current pathologic fracture is complex and depends on various factors, including the type and severity of the fracture, as well as the underlying condition causing the fracture.
Studies on Bisphosphonates and Fracture Healing
- A study published in 2020 2 found that initiating bisphosphonates as early as 2 weeks post-fracture does not increase rates of non-union or malunion.
- Another study published in 2012 3 compared the effectiveness of different pharmacological agents in reducing the risk of fragility fractures and found that bisphosphonates, including alendronate, are effective in reducing the risk of fractures.
Considerations for Pathologic Fractures
- A study published in 2022 4 highlighted the importance of proper diagnosis and treatment of pathologic fractures, as misdiagnosis and treatment as a simple fracture can lead to poor outcomes.
- It is essential to consider the underlying condition causing the pathologic fracture and to manage it appropriately, in addition to treating the fracture itself.
Combination Therapy with Fosamax
- A study published in 2025 5 compared the efficacy of teriparatide combined with bisphosphonates or denosumab versus teriparatide monotherapy in osteoporosis treatment and found that combination therapy can be effective in enhancing bone mineral density.
- However, the study did not specifically address the use of Fosamax with a current pathologic fracture, and more research is needed to determine the safety and efficacy of this approach.