From the Guidelines
The starting dose of alendronate for osteoporosis treatment or prevention is 70 mg once weekly or 10 mg daily, and 35 mg once weekly or 5 mg daily, respectively. According to the American Family Physician 1, the recommended dosages for alendronate are as follows:
- 5 mg per day or 35 mg per week for prevention
- 10 mg per day or 70 mg per week for treatment It is essential to take alendronate first thing 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 the medication to prevent esophageal irritation. The once-weekly regimen is generally preferred due to improved adherence and reduced gastrointestinal side effects. Alendronate works by inhibiting osteoclast-mediated bone resorption, thereby increasing bone mineral density and reducing fracture risk. Treatment duration typically ranges from 3-5 years initially, after which fracture risk should be reassessed. Patients should also ensure adequate calcium (1000-1200 mg daily) and vitamin D (800-1000 IU daily) intake while on alendronate therapy to optimize bone health outcomes. Key considerations for alendronate therapy include:
- Contraindications: abnormalities of the esophagus, inability to stand or sit upright for at least 30 minutes, and hypersensitivity to any component of the product
- Potential side effects: gastrointestinal irritation, hypocalcemia
- Importance of patient education on proper administration and potential side effects to ensure safe and effective treatment.
From the FDA Drug Label
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 of virtually identical design, one performed in the United States and the other in 15 different countries (Multinational [which also included alendronate sodium 2. 5 mg/day]). Daily Dosing 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) 14. 2 Prevention of Osteoporosis in Postmenopausal Women Daily Dosing Prevention of bone loss was demonstrated in two double-blind, placebo-controlled studies of postmenopausal women 40-60 years of age. One thousand six hundred nine patients (alendronate sodium 5 mg/day; n=498)
The starting dose of Alendronate (bisphosphonate) is 5 mg/day for the prevention of osteoporosis in postmenopausal women and 10 mg/day for the treatment of osteoporosis in men. 2 2
- 5 mg/day is used for prevention of osteoporosis in postmenopausal women
- 10 mg/day is used for treatment of osteoporosis in men Note that the dose may vary based on the specific condition being treated, such as glucocorticoid-induced osteoporosis.
From the Research
Alendronate Starting Dose
The starting dose of Alendronate (bisphosphonate) can vary depending on the specific treatment regimen.
- The daily dose is 5 or 10 mg/day, as indicated in the study 3.
- The once-weekly dose is 70 mg, which is therapeutically equivalent to the daily regimen, as reported in the studies 4, 5, and 6.
- The twice-weekly dose is 35 mg, as mentioned in the study 7.
Treatment Regimens
Different treatment regimens have been studied, including:
- Once-daily dosing with 10 mg of alendronate, as mentioned in the studies 3, 4, and 5.
- Once-weekly dosing with 70 mg of alendronate, as reported in the studies 4, 5, and 6.
- Twice-weekly dosing with 35 mg or 70 mg of alendronate or risedronate, as mentioned in the study 7.
Patient Preference
Patient preference for once-weekly versus once-daily dosing with alendronate has been studied, with most patients preferring the once-weekly regimen, as reported in the studies 4 and 5.