From the Guidelines
Alendronate is typically prescribed at a dose of 70 mg once weekly for the treatment of osteoporosis in adults, or 35 mg once weekly for prevention, as recommended by the most recent guidelines 1. The medication should be taken in the morning with a full glass of plain water (6-8 ounces) at least 30 minutes before consuming any food, beverages, or other medications.
- Patients must remain upright (sitting or standing) for at least 30 minutes after taking alendronate to prevent esophageal irritation.
- The typical treatment duration is 3-5 years, though some patients may benefit from longer therapy based on their fracture risk.
- Calcium (1000-1200 mg daily) and vitamin D (800-1000 IU daily) supplements are usually recommended alongside alendronate therapy, as suggested by recent studies 2. This medication works by inhibiting bone resorption by osteoclasts, thereby increasing bone mineral density and reducing fracture risk.
- Patients with severe renal impairment (creatinine clearance <35 mL/min) should not use alendronate, and those with esophageal disorders may need alternative treatments. The most recent guidelines from the American College of Rheumatology 1, 2 support the use of alendronate as a first-line treatment for osteoporosis, with a strong recommendation for its use in patients at high or very high risk of fracture.
From the FDA Drug Label
The therapeutic equivalence of once weekly alendronate sodium 35 mg (n=362) and alendronate sodium 5 mg daily (n=361) was demonstrated in a one-year, double-blind, multicenter study of postmenopausal women without osteoporosis. A two-year, double-blind, placebo-controlled, multicenter study of alendronate sodium 10 mg once daily enrolled a total of 241 men between the ages of 31 and 87 (mean, 63) A one-year, double-blind, placebo-controlled, multicenter study of once weekly alendronate sodium 70 mg enrolled a total of 167 men between the ages of 38 and 91 (mean, 66) The efficacy of alendronate sodium 5 and 10 mg once daily in men and women receiving glucocorticoids (at least 7. 5 mg/day of prednisone or equivalent) was demonstrated in two, one-year, double-blind, randomized, placebo-controlled, multicenter studies
The recommended dosage of Alendronate (bisphosphonate) is:
- 5 mg daily for the prevention of bone loss in postmenopausal women
- 10 mg daily for the treatment of osteoporosis in postmenopausal women and men
- 35 mg once weekly for the prevention of bone loss in postmenopausal women
- 70 mg once weekly for the treatment of osteoporosis in men
- 5 and 10 mg once daily for the treatment of glucocorticoid-induced osteoporosis in men and women 3
From the Research
Recommended Dosage of Alendronate
The recommended dosage of Alendronate (bisphosphonate) is:
- 70 mg once a week for osteoporosis, as stated in the study 4
- 10 mg daily, as mentioned in the studies 5, 6, and 7
- 35 mg twice a week, as mentioned in the studies 5 and 6
Efficacy of Different Dosage Regimens
The studies 6 and 7 compared the efficacy of different dosage regimens, including:
- Once-weekly alendronate 70 mg
- Twice-weekly alendronate 35 mg
- Daily alendronate 10 mg These studies found that the different dosage regimens were therapeutically equivalent, with similar increases in bone mineral density (BMD) and reductions in biochemical markers of bone resorption.
Patient Preference and Tolerability
The study 8 found that:
- 96% of patients preferred the once-weekly alendronate regimen to the daily dosage
- 98% of patients who completed 12 weeks of treatment were willing to continue the once-weekly regimen
- Patient-reported compliance with dosing instructions was over 98%
- Alendronate once-weekly was well tolerated, with only 2.8% of patients discontinuing due to adverse events.