Alendronate is the most common medicine prescribed for the treatment of osteoporosis in the United States. Alendronate is a generic medicine manufactured by multiple companies. The brand name Fosamax from Merck provides all the research evidence for effectiveness for alendronate in reducing spine, hip, and nonspine fractures. The patent for Fosamax expired in 2008.

Alendronate is in the class of medicines called bisphosphonates that also includes ActonelAtelviaBoniva, generic ibandronate, and Reclast. They work by decreasing the rate that bone is broken down. This reduction in bone turnover results in stabilizing or building up bone mass that results in decreasing risk of fractures.

Tablet Requires Special Dosing Instructions

Alendronate is a tablet taken by mouth usually once a week. Because alendronate is poorly absorbed if you eat or drink something at the same time, special instructions for taking the medicine need to be followed:

Alendronate is taken first thing in the morning on an empty stomach with 6 to 8 ounces of plain water. You must wait one half an hour before taking any food, drinks, or other medicines. During this time you also must remain upright to help ensure the medicine reaches the stomach and causes no irritation to the esophagus.

Who Should Consider Alendronate?

The indications for taking alendronate are that you are high risk for breaking a bone or taking steroid medicines that put you at higher risk for breaking a bone. Alendronate is approved for use in both men and women. The goal of taking this medicine is to decrease your risk of breaking a bone.

Side Effects of Alendronate

As with any medicine, side effects are possible when taking alendronate. The most common side effects are digestive system problems including nausea, heartburn, diarrhea, or constipation.

A “Medication Guide” that is included with the dispensing of alendronate and all the bisphosphonate-class medicines details 5 potential serious side effects:

1. Esophagus problems

2. Low calcium levels in your blood (hypocalcaemia)

3. Severe jaw bone problems (osteonecrosis)

4. Bone, joint, or muscle pain

5. Unusual thigh bone fractures

Overall alendronate is well tolerated and these serious side effects occur infrequently. Read more about osteonecrosis of the jaw and atypical femur fractures.

How Long Should You Take Alendronate?

The length of use of alendronate and all bisphosphonates is being debated. The recent FDA labeling includes “The optimal duration of use has not been determined. Patients should have the need for continued therapy re-evaluated on a periodic basis.” Find additional information under the topic “drug holiday.”

Discuss with your doctor or healthcare practitioner your individual risk and whether this medicine would be appropriate for you to use.

Other resources:

Binosto is another formulation of alendronate: an effervescent tablet that is dissolved in water