What patient education is recommended for osteoporosis treatment with Fosamax (alendronate)?

Patient Education for Osteoporosis Treatment with Fosamax (Alendronate)

Patients taking Fosamax (alendronate) for osteoporosis should take it on an empty stomach after an overnight fast, with a full glass of plain water, and remain upright for at least 30 minutes afterward to ensure optimal absorption and minimize adverse effects. 1

Administration Instructions

• Dosing options:

  • 70 mg once weekly (preferred) or 10 mg daily for treatment 1
  • 35 mg once weekly or 5 mg daily for prevention 1
  • Once-weekly dosing is preferred as it improves patient compliance while maintaining equivalent efficacy 2, 3, 4

• Proper administration technique:

  • Take after an overnight fast (empty stomach)
  • Swallow with a full glass (6-8 oz) of plain water only
  • Remain upright (sitting or standing) for at least 30 minutes after taking
  • Do not eat, drink other beverages, or take other medications for at least 30 minutes 1, 5

Supplementation Requirements

• Calcium supplementation: 1000-1200 mg daily
• Vitamin D supplementation: 600-800 IU daily 1
• Take calcium and vitamin D supplements at a different time of day than alendronate to avoid interference with absorption

Potential Side Effects

• Common side effects:

  • Upper GI symptoms (abdominal pain, dyspepsia, acid regurgitation)
  • Musculoskeletal pain 1

• Rare but serious side effects:

  • Osteonecrosis of the jaw
  • Atypical femoral fractures 1
  • Esophageal ulcerations (risk reduced with proper administration) 5

Contraindications

Educate patients that alendronate is contraindicated in:

• Severe renal impairment (creatinine clearance <35 mL/min)
• Hypocalcemia
• Esophageal abnormalities
• Inability to stand/sit upright for at least 30 minutes
• Hypersensitivity to any component of the product 1

Monitoring and Follow-up

• Bone mineral density (BMD) testing with vertebral fracture assessment or spinal x-ray every 1-2 years during treatment 6
• The optimal duration of therapy is typically 5 years, after which continuation should be reassessed 1

Efficacy Expectations

Patients should understand that alendronate:

• Reduces vertebral fractures by 47-56%
• Reduces hip fractures by approximately 50%
• Reduces all clinical fractures by approximately 30% 1
• Increases bone mineral density at the spine by approximately 5-7% after one year of treatment 2, 3

Importance of Adherence

• Emphasize that consistent adherence to the medication regimen and proper administration technique are essential for effectiveness
• Once-weekly dosing (70 mg) is therapeutically equivalent to daily dosing and may enhance long-term adherence 2, 3
• Studies show that 86.4% of patients prefer the once-weekly dosing regimen over daily dosing 4

When to Contact Healthcare Provider

Instruct patients to contact their healthcare provider if they experience:

• Severe heartburn or difficulty swallowing
• Chest pain
• New or worsening heartburn
• Thigh or groin pain
• Jaw pain or swelling