What tests are required prior to starting Fosamax (alendronate)?

Required Tests Before Starting Fosamax (Alendronate)

Before starting Fosamax (alendronate), patients should have serum calcium measured and undergo a dental assessment where feasible. 1, 2

Essential Laboratory Tests

• Serum calcium must be measured prior to starting treatment with alendronate, as hypocalcemia is a contraindication and must be corrected before initiating therapy 1, 2
• Renal function should be assessed through serum creatinine measurement, as alendronate is not recommended for patients with creatinine clearance less than 35 mL/min 1
• For patients receiving intravenous bisphosphonates (such as zoledronic acid), more extensive monitoring is required, including renal function prior to starting treatment and monitoring of serum calcium and serum creatinine throughout the treatment period 2

Dental Assessment

• A dental assessment is recommended, where feasible, prior to starting bisphosphonates 2
• Any pending dental or oral health problems should be addressed before starting treatment when possible 2
• This recommendation is based on the risk of osteonecrosis of the jaw (ONJ), which can occur with bisphosphonate use, particularly with tooth extractions and other invasive dental procedures 1
• The risk of ONJ increases with frequency, dose, and duration of bisphosphonate administration 2

Bone Health Evaluation

• In patients with risk factors for osteoporosis, it may be appropriate to evaluate bone mineral density using dual-energy X-ray absorptiometry (DXA) 2
• This is particularly important when other risk factors for osteoporosis are present 2

Vitamin D and Calcium Supplementation

• Calcium and vitamin D supplementation is recommended unless otherwise contraindicated 2
• It's important to note that oral bisphosphonates and calcium should not be taken concurrently; they should be separated by at least 2 hours to allow for maximum absorption 2

Common Pitfalls to Avoid

• Failing to correct hypocalcemia before starting alendronate therapy 1
• Not addressing vitamin D deficiency or other disorders affecting mineral metabolism before starting treatment 1
• Neglecting to inform patients about proper administration of alendronate (must be taken with a full glass of water and remain upright for at least 30 minutes) to avoid esophageal adverse effects 1
• Overlooking the need for dental evaluation and care prior to initiating bisphosphonate therapy 2
• Not informing patients about the risk of developing osteonecrosis of the jaw, especially with tooth extractions and other invasive dental procedures 2

By ensuring these tests are completed before initiating Fosamax therapy, clinicians can minimize risks and optimize treatment outcomes for patients requiring bisphosphonate therapy.