From the Guidelines
Alendronate can cause several side effects, including mild upper gastrointestinal symptoms, atypical subtrochanteric fractures, and osteonecrosis of the jaw, as reported in a high-quality study published in the Annals of Internal Medicine 1. The most common side effects of alendronate include:
- Gastrointestinal issues such as heartburn, stomach pain, nausea, and acid reflux, which occur in approximately 10-30% of patients
- Musculoskeletal pain, which can range from mild to severe
- Allergic reactions, which are uncommon but can include rash, itching, and swelling
- Esophageal irritation or ulceration, which can occur if the medication is not taken properly More serious but rare side effects include:
- Osteonecrosis of the jaw (death of jawbone tissue), which primarily occurs in patients undergoing dental procedures while on the medication
- Atypical femur fractures with long-term use (typically after 5+ years of therapy)
- Hypocalcemia (low blood calcium), which is possible, especially in patients with vitamin D deficiency
- Eye inflammation (uveitis and scleritis), which has been reported in rare cases It is essential to note that the benefits of alendronate in preventing bone fractures in osteoporosis patients should be balanced against these potential side effects, as recommended by the American College of Physicians 1. Key considerations for minimizing side effects include:
- Taking the medication with a full glass of water first thing in the morning
- Remaining upright for at least 30 minutes after taking the medication
- Not consuming food or other medications during this time
- Considering calcium and vitamin D supplements to prevent hypocalcemia
- Regular monitoring for signs of osteonecrosis of the jaw and atypical femur fractures.
From the FDA Drug Label
Alendronate sodium tablets, USP can cause serious side effects including: Esophagus problems Low calcium levels in your blood (hypocalcemia) Bone, joint, or muscle pain Severe jaw bone problems (osteonecrosis) Unusual thigh bone fractures The most common side effects of alendronate sodium tablets, USP are: Stomach area (abdominal) pain Heartburn Constipation Diarrhea Upset stomach Pain in your bones, joints, or muscles Nausea
The side effects of Alendronate (bisphosphonate) include:
- Esophagus problems: irritation, inflammation, or ulcers of the esophagus
- Low calcium levels in your blood (hypocalcemia)
- Bone, joint, or muscle pain
- Severe jaw bone problems (osteonecrosis)
- Unusual thigh bone fractures
- Stomach area (abdominal) pain
- Heartburn
- Constipation
- Diarrhea
- Upset stomach
- Pain in your bones, joints, or muscles
- Nausea 2, 2, 2
From the Research
Side Effects of Alendronate
The side effects of Alendronate (bisphosphonate) include:
- Upper gastrointestinal tract adverse events, such as abdominal pain, nausea, dyspepsia, acid regurgitation, and musculoskeletal pain 3, 4
- Esophageal lesions, including severe esophagitis, erosions, and ulcerations, which can be caused by taking the drug with little or no water, lying down during or after ingestion, or having preexisting esophageal disorders 5
- Gastric ulcers, with potentially clinically significant gastric mucosal injury, including antral ulcers and large superficial antral erosions 6
- Oesophageal damage, including multiple linear superficial erosions in the mid and distal oesophagus 6
- Chemical esophagitis, which can be severe and may require hospitalization 5, 7
Risk Factors for Side Effects
Certain factors can increase the risk of side effects from Alendronate, including:
- Taking the drug with little or no water 5
- Lying down during or after ingestion of the tablet 5
- Having preexisting esophageal disorders 5
- Noncompliance with the manufacturer's recommendations for administration of the drug 4
Minimizing the Risk of Side Effects
To minimize the risk of side effects, it is recommended to: