Fosamax (alendronate sodium) is a first-line bisphosphonate medication clinically proven to treat and prevent osteoporosis in postmenopausal women and increase bone mass in men with osteoporosis. It works by inhibiting osteoclast-mediated bone resorption, thereby slowing bone loss, increasing bone mineral density, and significantly reducing the incidence of vertebral and hip fractures. Prescribed under professional supervision, it represents a cornerstone in the long-term management of osteoporotic conditions, supported by extensive clinical research and decades of real-world use.

Features

• Active ingredient: Alendronate sodium
• Available in oral tablet formulations (e.g., 5 mg, 10 mg, 35 mg, 70 mg)
• Belongs to the bisphosphonate class of drugs
• Inhibits osteoclast-mediated bone resorption
• Once-weekly or daily dosing options for patient convenience
• Requires specific administration instructions to ensure optimal absorption and minimize esophageal irritation

Benefits

• Significantly increases bone mineral density at the spine and hip
• Reduces the risk of vertebral fractures by up to 50% in postmenopausal women with osteoporosis
• Lowers the incidence of non-vertebral fractures, including hip fractures
• Helps maintain skeletal integrity and strength over the long term
• Supports independence and quality of life by preventing debilitating fractures
• May be used in combination with calcium and vitamin D supplementation for comprehensive bone health

Common use

Fosamax is primarily indicated for the treatment of osteoporosis in postmenopausal women. It is also approved for use in men with osteoporosis to increase bone mass. Additionally, it is prescribed for the prevention of osteoporosis in postmenopausal women considered at risk of developing the condition. In some cases, it may be used under specialist guidance for the treatment of glucocorticoid-induced osteoporosis in men and women receiving sustained corticosteroid therapy, and for the treatment of Paget’s disease of bone.

Dosage and direction

The typical dosage for treating osteoporosis in postmenopausal women and men is 70 mg once weekly or 10 mg once daily. For prevention of osteoporosis in postmenopausal women, the usual dose is 35 mg once weekly or 5 mg once daily. For Paget’s disease, the recommended dose is 40 mg once daily for six months.

Take Fosamax first thing in the morning, at least 30 minutes before the first food, beverage, or other medication of the day. Swallow the tablet whole with a full glass (6–8 oz) of plain water only. Do not chew, suck, or crush the tablet. Remain upright (sitting or standing) for at least 30 minutes after taking the medication and until after the first food of the day. Do not lie down during this period. This minimizes the risk of esophageal irritation and ensures proper absorption.

Precautions

Prior to initiating therapy, correct hypocalcemia and other disturbances of bone and mineral metabolism. Ensure adequate intake of calcium and vitamin D. Use caution in patients with active upper gastrointestinal problems (such as dysphagia, esophageal disease, gastritis, duodenitis, or ulcers). Not recommended in patients with esophageal abnormalities that delay emptying (e.g., stricture or achalasia). Use with caution in patients with renal impairment (creatinine clearance <35 mL/min is not recommended). Dental exams are advisable before starting treatment; inform your dentist you are taking Fosamax, as there is a risk of osteonecrosis of the jaw. Atypical femoral fractures have been reported with long-term use; report any thigh or groin pain.

Contraindications

Fosamax is contraindicated in patients with abnormalities of the esophagus which delay emptying (e.g., stricture or achalasia). It must not be used in individuals unable to stand or sit upright for at least 30 minutes. Do not use in patients with hypocalcemia. Contraindicated in those with hypersensitivity to alendronate sodium or any component of the formulation. Not recommended for use in patients with severe renal impairment (CrCl <35 mL/min).

Possible side effect

Common side effects may include abdominal pain, acid regurgitation, constipation, diarrhea, dyspepsia, musculoskeletal pain, nausea, and esophageal ulcer. Less frequently, patients may experience headache, blurred vision, rash, or pruritus. Serious side effects, though rare, can include severe esophageal reactions (esophagitis, erosions, ulcers, stricture), osteonecrosis of the jaw, atypical subtrochanteric and diaphyseal femoral fractures, and severe bone, joint, and/or muscle pain. Hypocalcemia may occur, particularly in patients with predisposing conditions.

Drug interaction

Calcium supplements, antacids, and other products containing polyvalent cations (such as iron, magnesium, aluminum) can significantly interfere with the absorption of Fosamax. Administer these at a different time of day (at least 30 minutes after Fosamax). Aspirin and other NSAIDs may increase the risk of gastrointestinal irritation when co-administered. Use caution with medications that lower calcium levels, such as loop diuretics. There are no known clinically significant interactions with cytochrome P450 enzymes.

Missed dose

If a once-daily dose is missed, do not take it later in the day. Skip the missed dose and resume the usual schedule the next morning. Do not take two tablets on the same day. If a once-weekly dose is missed, take one tablet on the morning after it is remembered, then return to the original weekly schedule on the chosen day. Do not take two tablets in the same week.

Overdose

Hypocalcemia, hypophosphatemia, and upper gastrointestinal adverse events (such as upset stomach, heartburn, esophagitis, gastritis, or ulcer) may occur. Milk or antacids may be given to bind alendronate and reduce absorption. However, due to the risk of esophageal irritation, do not induce vomiting or give anything by mouth to an unconscious person. Maintain a full upright position. Supportive care and monitoring of serum calcium and electrolytes are indicated. Dialysis is not beneficial.

Storage

Store at room temperature between 20°C to 25°C (68°F to 77°F), in a dry place, in the original container. Keep tightly closed to protect from moisture. Keep out of reach of children and pets. Do not use after the expiration date printed on the bottle.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Do not disregard professional medical advice or delay in seeking it because of something you have read here.

Reviews

“After five years on Fosamax, my DEXA scans show remarkable improvement in bone density. No fractures despite a fall last winter. Strict adherence to dosing instructions is key to avoiding stomach issues.” – Maria T., age 68

“Prescribed Fosamax following early menopause and family history of osteoporosis. The once-weekly dose is convenient. I experienced mild heartburn initially, but it subsided. Annual scans confirm stable bone health.” – Susan L., age 55

“My rheumatologist started me on Fosamax for glucocorticoid-induced bone loss. It halted the decline effectively. I make sure to take it with a full glass of water and remain upright—no gastrointestinal problems.” – James K., age 62