Is Fosamax (alendronate) suitable for a 71-year-old female with osteoporosis in the hips?

From the Guidelines

Fosamax (alendronate) is a suitable treatment option for a 71-year-old female with osteoporosis in the hips, as it has been shown to reduce the risk of hip and vertebral fractures in women with known osteoporosis 1.

Key Points to Consider

• Fosamax belongs to the bisphosphonate class, which works by slowing bone breakdown and allowing bone-building cells to work more effectively, helping to increase bone density and reduce fracture risk.
• The typical dosage is 70 mg once weekly or 10 mg daily, taken first thing in the morning with a full glass of water, at least 30 minutes before any food, beverage, or other medications.
• Side effects may include stomach pain, nausea, and rarely, jaw problems or unusual fractures with long-term use.
• Regular dental check-ups are important while taking this medication, and calcium and vitamin D supplements are typically recommended alongside Fosamax.
• Individual factors like kidney function and other medications may affect suitability, so it's essential to follow the doctor's specific recommendations.

Evidence-Based Recommendations

• The American College of Physicians recommends offering pharmacologic treatment with alendronate, risedronate, zoledronic acid, or denosumab to reduce the risk for hip and vertebral fractures in women who have known osteoporosis 1.
• High-quality evidence shows that bisphosphonates, including alendronate, reduce vertebral, nonvertebral, and hip fractures compared with placebo in postmenopausal osteoporotic women 1.
• The treatment should be tailored to the individual patient's needs, taking into account their medical history, lifestyle, and preferences.

From the FDA Drug Label

Alendronate sodium tablets, USP are indicated for the treatment of osteoporosis in postmenopausal women. In postmenopausal women, alendronate sodium tablets, USP increase bone mass and reduce the incidence of fractures, including those of the hip and spine (vertebral compression fractures).

The bone mineral density efficacy of alendronate sodium 10 mg once daily in postmenopausal women, 44 to 84 years of age, with osteoporosis (lumbar spine bone mineral density [BMD] of at least 2 standard deviations below the premenopausal mean) was demonstrated in four double-blind, placebo-controlled clinical studies of two or three years' duration

In the Four-Year Study of FIT, alendronate sodium reduced the percentage of osteoporotic women experiencing multiple vertebral fractures from 0.6% to 0.1% (78% relative risk reduction, p=0.035).

Alendronate sodium was similarly effective regardless of age, race, baseline rate of bone turnover, and baseline BMD in the range studied (at least 2 standard deviations below the premenopausal mean)

Fosamax (alendronate) is likely ok for a 71-year-old female with osteoporosis in the hips, as it has been shown to increase bone mass and reduce the incidence of fractures, including hip fractures, in postmenopausal women with osteoporosis 2, 2.

• Key benefits of alendronate include:
  • Increased bone mineral density
  • Reduced incidence of vertebral and hip fractures
  • Effective in postmenopausal women with osteoporosis
• Important considerations:
  • The optimal duration of use has not been determined
  • Patients at low-risk for fracture should be considered for drug discontinuation after 3 to 5 years of use 2

From the Research

Osteoporosis Treatment with Fosamax

• Fosamax, also known as alendronate, is a bisphosphonate used to treat osteoporosis in older adults 3, 4, 5, 6, 7.
• The medication has been shown to reduce the risk of hip, spine, and wrist fractures in osteoporotic women by approximately one half 7.
• A cost-effectiveness analysis of alendronate found that treating 71-year-old osteoporotic women with a prior spine fracture with alendronate resulted in a cost per quality-adjusted life-year (QALY) gained of SEK76000, which is well below the threshold for cost effectiveness of SEK300000 7.

Considerations for Treatment

• The selection of osteoporosis treatment should be individualized and based on a variety of factors, including underlying fracture risk, medical comorbidities, medication burden, as well as fracture risk reduction profiles, modes of administration, and side effects of treatment options 4.
• Bisphosphonates, such as alendronate, are a first-line therapy for many patients with osteoporosis 5.
• Other treatments for osteoporosis include denosumab, teriparatide, abaloparatide, romosozumab, and selective estrogen receptor modulators 5, 6.

Specific Considerations for a 71-Year-Old Female with Osteoporosis in Hips

• For a 71-year-old female with osteoporosis in hips, alendronate may be a suitable treatment option, as it has been shown to reduce the risk of hip fractures in women with osteoporosis 6, 7.
• However, the treatment decision should be individualized, taking into account the patient's medical history, comorbidities, and other factors 4.