From the Guidelines
Fosamax (alendronate) should be prescribed at 70 mg once weekly for treating osteoporosis in adults, as this regimen is generally preferred due to better adherence and similar efficacy to daily dosing, as recommended by the American College of Physicians in their 2023 living clinical guideline 1. The once-weekly regimen of Fosamax is preferred over the daily dosing due to its better adherence and similar efficacy. Patients should take Fosamax with a full glass of plain water (6-8 oz) first thing in the morning, at least 30 minutes before consuming any food, beverages, or other medications. After taking the medication, patients must remain upright (sitting or standing) for at least 30 minutes to reduce the risk of esophageal irritation.
Key Considerations
- Calcium (1000-1200 mg daily) and vitamin D (800-1000 IU daily) supplements are recommended alongside Fosamax unless contraindicated, as supported by previous guidelines 1.
- Treatment duration typically ranges from 3-5 years initially, after which a risk reassessment should be conducted to determine whether to continue, take a drug holiday, or switch therapies.
- Fosamax works by inhibiting osteoclast-mediated bone resorption, thereby increasing bone mineral density and reducing fracture risk.
- Common side effects include gastrointestinal disturbances, musculoskeletal pain, and headache, as reported in previous studies 1.
- Rare but serious adverse effects include osteonecrosis of the jaw and atypical femur fractures, particularly with long-term use, as noted in the 2023 guideline 1.
Patient Education
- Patients should be educated on the importance of adherence to the prescribed regimen and the potential side effects of Fosamax.
- They should also be informed about the need for regular follow-up appointments to monitor their bone density and adjust their treatment plan as needed.
- The 2023 guideline from the American College of Physicians recommends bisphosphonates, such as alendronate, as first-line treatment for primary osteoporosis in both females and males 1.
From the FDA Drug Label
The efficacy of alendronate sodium in men with hypogonadal or idiopathic osteoporosis was demonstrated in two clinical studies. Daily Dosing 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) Weekly Dosing 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 recommended treatment and dosage for Fosamax (alendronate) in patients with osteoporosis is:
- Daily Dosing: 10 mg once daily
- Weekly Dosing: 70 mg once weekly These dosages have been shown to be effective in increasing bone mass and reducing the risk of fractures in patients with osteoporosis 2.
From the Research
Recommended Treatment and Dosage for Fosamax (Alendronate)
The recommended treatment and dosage for Fosamax (alendronate) in patients with osteoporosis vary based on the specific condition being treated.
- For postmenopausal women with osteoporosis, the recommended dosage is 70 mg once weekly or 10 mg once daily 3, 4.
- For men with primary osteoporosis, the recommended dosage is 70 mg once weekly or 10 mg once daily 4.
- For patients with corticosteroid-induced osteoporosis, the recommended dosage is 5 mg once daily 4.
Administration Instructions
It is essential to follow specific administration instructions to minimize the risk of upper GI adverse events:
- Take alendronate in the morning with a full glass of water at least 30 minutes before consuming any food or beverages 3, 4.
- Do not lie down after taking alendronate until after the first food of the day 4.
Efficacy and Safety
Alendronate has been shown to be effective in increasing bone mineral density and reducing the risk of fractures in patients with osteoporosis:
- In postmenopausal women, alendronate reduced the risk of radiographic vertebral fracture, clinical vertebral fracture, or hip fracture by 47 to 56% 4.
- Alendronate was generally well tolerated, with most adverse events being transient and associated with the upper GI tract 4, 5.
Potential Adverse Events
While alendronate is generally well tolerated, there is a risk of upper GI adverse events, including esophagitis: