From the Research
Alendronate typically does not need to be stopped before surgery, and most patients can continue taking it up to and including the day of surgery. This is because alendronate, a bisphosphonate, works by slowing bone breakdown and increasing bone density, primarily used to treat osteoporosis, and has a very long half-life in bone tissue, so temporarily stopping it for surgery would not significantly affect its therapeutic benefits 1. The medication does not increase surgical bleeding risk or interfere with anesthesia, unlike blood thinners or certain other medications. However, in specific cases such as major oral surgery, dental extractions, or jaw surgery, the surgeon might recommend stopping alendronate temporarily due to a rare but serious risk of osteonecrosis of the jaw.
Some studies have shown that early administration of bisphosphonates after surgery did not appear to delay fracture healing time either radiologically or clinically, and the anti-resorptive efficacy of bisphosphonates given immediately after surgical repair should positively affect the rate of subsequent fractures 1. Additionally, local elution of alendronic acid has been shown to increase net periimplant bone formation in an animal model, which could potentially improve the biologic fixation of porous reconstructive implants 2.
It is essential to discuss the complete medication list with both the surgeon and the physician who prescribed the alendronate before any surgical procedure, as individual circumstances may warrant different recommendations. The most recent and highest quality study on this topic is from 2024, which found that tranexamic acid is probably the most effective intervention for preventing bleeding in people undergoing hip or knee replacement surgery, but it does not provide direct evidence on the use of alendronate in surgery 3.
In terms of specific guidelines, there is no clear recommendation to stop alendronate 5 days before surgery, and the decision to continue or stop the medication should be made on a case-by-case basis, considering the type of surgery, the patient's overall health, and the potential risks and benefits of continuing or stopping the medication.
- Key points to consider:
- Alendronate does not typically need to be stopped before surgery
- The medication has a long half-life in bone tissue, so temporary cessation would not significantly affect its therapeutic benefits
- Specific cases, such as major oral surgery or jaw surgery, may require temporary cessation due to the risk of osteonecrosis of the jaw
- Early administration of bisphosphonates after surgery does not appear to delay fracture healing time
- Local elution of alendronic acid can increase net periimplant bone formation in an animal model
- Individual circumstances may warrant different recommendations, and the decision to continue or stop the medication should be made on a case-by-case basis.