From the Guidelines
Alendronate is a first-line treatment for primary osteoporosis or low bone mass to prevent fractures in adults, particularly postmenopausal women and men with osteoporosis, due to its favorable balance of benefits, harms, and cost, as evidenced by the most recent and highest quality study 1. The medication belongs to a class of drugs called bisphosphonates, which work by slowing bone breakdown while allowing normal bone building to continue, increasing bone density and reducing fracture risk. Key points to consider when prescribing alendronate include:
- The standard dose for osteoporosis treatment is 70 mg once weekly or 10 mg daily, while prevention typically requires 35 mg weekly or 5 mg daily.
- Alendronate must be taken on an empty stomach with a full glass of water, after which patients should remain upright for at least 30 minutes to prevent esophageal irritation.
- Common side effects include stomach pain, heartburn, and muscle pain, as well as a higher risk for osteonecrosis of the jaw and atypical femoral or subtrochanteric fractures, although the certainty of evidence for these risks is low 1.
- Adequate calcium and vitamin D intake should accompany alendronate therapy to maximize its effectiveness in maintaining bone health.
- The medication is typically prescribed for 3-5 years initially, after which a "drug holiday" may be considered based on fracture risk assessment, as supported by previous guidelines 1.
From the FDA Drug Label
Alendronate is a bisphosphonate that binds to bone hydroxyapatite and specifically inhibits the activity of osteoclasts, the bone-resorbing cells. 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. It works by inhibiting bone resorption, which helps to increase bone mass and reduce the risk of fractures 2.
- Key benefits:
- Inhibits osteoclast activity
- Reduces bone resorption
- Increases bone mass
- Reduces risk of fractures
- Target population: Postmenopausal women with osteoporosis.
From the Research
Use of Alendronate
Alendronate is a nitrogen-containing bisphosphonate that binds to bone surfaces and inhibits bone resorption by osteoclasts 3. The primary use of alendronate is in the treatment and prevention of osteoporosis in postmenopausal women and men, as well as in the treatment of corticosteroid-induced osteoporosis 3, 4.
Mechanism of Action
Alendronate works by suppressing the activity of osteoclasts, which are cells that break down bone tissue 4. This leads to an increase in bone mass and a reduction in the risk of fractures.
Efficacy
Studies have shown that alendronate is effective in increasing bone mineral density (BMD) and reducing the risk of fractures in postmenopausal women with osteoporosis 3, 4, 5. Alendronate has also been shown to be effective in preventing osteoporosis in postmenopausal women 5.
Dosage and Administration
Alendronate is available in a variety of dosages, including 5mg/day, 10mg/day, 35mg twice weekly, and 70mg once weekly 3, 6. The once-weekly dosing regimen has been shown to be therapeutically equivalent to the daily regimen 6.
Comparison to Other Treatments
Alendronate has been compared to other treatments for osteoporosis, including risedronate, and has been shown to produce greater gains in BMD and greater reductions in markers of bone turnover 7.
Key Points
- Alendronate is a bisphosphonate that inhibits bone resorption by osteoclasts
- Effective in increasing BMD and reducing the risk of fractures in postmenopausal women with osteoporosis
- Available in a variety of dosages, including once-weekly and daily regimens
- Has been shown to be more effective than risedronate in some studies
- Generally well-tolerated, with common side effects including abdominal pain, nausea, and dyspepsia 3, 4