What is the use of Alendronate (bisphosphonate)?

From the Guidelines

Alendronate should be used as first-line treatment in both females and males with primary osteoporosis to prevent fractures, due to its favorable balance of benefits, harms, patient values, and cost. The standard dose of alendronate is 70mg taken once weekly or 10mg daily [ 1 ]. It should be taken first thing in the morning with a full glass of plain water, at least 30 minutes before any food, beverage, or other medication, and patients must remain upright for at least 30 minutes after taking it to prevent esophageal irritation. Some key points to consider when prescribing alendronate include:

• Treatment duration typically ranges from 3-5 years, after which a "drug holiday" may be considered based on fracture risk assessment [ 1 ].
• Alendronate works by inhibiting osteoclasts, the cells that break down bone, thereby slowing bone loss and increasing bone density.
• Common side effects include gastrointestinal issues like heartburn, abdominal pain, and nausea.
• Rare but serious side effects include osteonecrosis of the jaw and atypical femur fractures, particularly with long-term use [ 1 ].
• Calcium and vitamin D supplements are typically recommended alongside alendronate to support bone health, but should be taken at a different time of day to avoid interference with alendronate absorption. It's worth noting that while other bisphosphonates like risedronate and zoledronate may also be effective, alendronate is a well-studied and commonly used option [ 1 ]. Additionally, denosumab may be considered as a second-line treatment in patients at high risk for fracture [ 1 ].

From the FDA Drug Label

Osteoporosis in Postmenopausal Women Osteoporosis is characterized by low bone mass that leads to an increased risk of fracture. Daily oral doses of alendronate (5,20, and 40 mg for six weeks) in postmenopausal women produced biochemical changes indicative of dose-dependent inhibition of bone resorption, including decreases in urinary calcium and urinary markers of bone collagen degradation

The use of Alendronate (bisphosphonate) is for the treatment and prevention of osteoporosis in postmenopausal women, which is characterized by low bone mass and increased risk of fracture. Alendronate works by inhibiting bone resorption, which leads to progressive gains in bone mass 2.

• Key indications:
  • Treatment of osteoporosis in postmenopausal women
  • Prevention of osteoporosis in postmenopausal women
• Mechanism of action:
  • Inhibition of osteoclast activity
  • Reduction of bone resorption
  • Increase in bone mass

From the Research

Use of Alendronate

• Alendronate is a nitrogen-containing bisphosphonate that binds to bone surfaces and inhibits bone resorption by osteoclasts 3.
• It is used to treat osteoporosis in postmenopausal women and men, as well as corticosteroid-induced osteoporosis 3, 4.
• Alendronate has been shown to increase bone mineral density (BMD) and reduce the risk of vertebral, nonvertebral, and hip fractures in postmenopausal women with osteoporosis 3, 5, 6.
• The recommended dosage of alendronate is 10 mg/day or 70 mg once weekly, which has been shown to be effective in increasing BMD and reducing fracture risk 3, 7.

Efficacy and Safety

• Alendronate has been shown to be effective in reducing the risk of vertebral fractures by 45-56% in postmenopausal women with osteoporosis 3, 5.
• It has also been shown to reduce the risk of nonvertebral fractures, including hip fractures, by 16-23% 5, 6.
• Alendronate is generally well tolerated, with common adverse events including abdominal pain, nausea, and dyspepsia 3, 4.
• However, there have been reports of rare but serious adverse events, including osteonecrosis of the jaw and upper gastrointestinal injury 5, 6.

Comparison with Other Treatments

• Alendronate has been compared with other treatments for osteoporosis, including raloxifene, calcitonin, and risedronate 4, 6, 7.
• It has been shown to be more effective than some of these treatments in increasing BMD and reducing fracture risk 3, 6.
• However, the choice of treatment should be based on individual patient needs and medical history 7.