What is the initial treatment regimen for alendronate?

Initial Treatment Regimen for Alendronate

For osteoporosis treatment, alendronate should be initiated at 70 mg once weekly or 10 mg once daily, taken with a full glass of water at least 30 minutes before the first food, beverage, or medication of the day. 1

Dosing Options Based on Indication

Treatment of Osteoporosis

• Postmenopausal women: 70 mg once weekly OR 10 mg once daily 2, 1
• Men with osteoporosis: 70 mg once weekly OR 10 mg once daily 1

Prevention of Osteoporosis

• Postmenopausal women: 35 mg once weekly OR 5 mg once daily 1

Glucocorticoid-Induced Osteoporosis

• Postmenopausal women not receiving estrogen: 10 mg once daily 1
• All other patients: 5 mg once daily 1

Administration Instructions

Critical Administration Requirements

• Take upon arising for the day 1
• Take with 6-8 ounces (full glass) of plain water only 1
• Wait at least 30 minutes before consuming any food, beverage, or other medication 1
• Remain upright (sitting or standing) for at least 30 minutes after taking the medication 1, 2
• Do not take at bedtime or before arising for the day 1

For Missed Doses

• If a once-weekly dose is missed, take one dose on the morning after remembering 1
• Do not take two doses on the same day 1
• Return to the original weekly schedule 1

Supplementation Requirements

Calcium and Vitamin D

• Calcium: 1000-1200 mg daily (total from diet and supplements) 2, 3
• Vitamin D: 800-1000 IU daily 2, 3
• For vitamin D deficiency (25(OH)D levels below 30 ng/mL):
  • Consider prescription vitamin D (ergocalciferol) 50,000 IU weekly for 8 weeks, followed by rechecking serum levels 2
  • Alternative for mild deficiency (20-30 ng/mL): Add 1000 IU over-the-counter vitamin D daily and recheck in 3 months 2

Advantages of Weekly Dosing

The once-weekly 70 mg dosing regimen has been shown to be therapeutically equivalent to the daily 10 mg regimen in terms of:

• Increases in bone mineral density 4, 5
• Reduction in bone turnover markers 4, 5
• Overall fracture risk reduction 5

Weekly dosing may offer several advantages:

• Improved patient convenience 4, 6
• Potentially enhanced compliance with therapy 4, 6
• Possibly reduced risk of esophageal adverse events 4

Precautions and Contraindications

Contraindications

• Abnormalities of the esophagus 1
• Inability to stand or sit upright for at least 30 minutes 1
• Hypocalcemia 1
• Hypersensitivity to alendronate or its components 1

Special Considerations

• Complete necessary dental work before initiating therapy to minimize risk of osteonecrosis of the jaw 3
• Monitor renal function, especially in patients with compromised kidney function 3
• Patients with gastrointestinal malabsorption may require higher doses of vitamin D supplementation 3

Monitoring Recommendations

• Baseline bone mineral density testing 3
• Baseline serum 25(OH)D levels (target ≥30 ng/mL) 3
• Periodic monitoring of bone turnover markers may be helpful to assess response 4

The once-weekly 70 mg alendronate regimen provides a convenient, effective option that may improve long-term adherence to therapy while maintaining equivalent efficacy to daily dosing for the treatment of osteoporosis.