Dangerous Side Effects Of Fosamax

Fosamax is a trade name for the medication alendronate, which is used for the treatment and prevention of osteoporosis. Alendronate belongs to the bisphosphonate drug group. Bones are living tissues that are in a constant state of turnover. Old bone is reabsorbed as new bone is formed. By inhibiting bone reabsorption, alendronate prevents osteoporosis and increases bone density in people who already have the condition. While usually well tolerated, alendronate may cause potentially dangerous side effects related to the esophagus and jaw.

Esophagitis and Esophageal Ulcers

Alendronate may cause irritation of the lining of the esophagus. The esophagus is the muscular tube that connects the stomach to the mouth. In a review article entitled, "Esophagitis Associated with the Use of Alendronate" published in "The New England Journal of Medicine," Dr. Piet de Groen and colleagues reported direct chemical injury of the esophagus uncommonly occurs with oral alendronate treatment. Esophagitis (irritation of the esophagus) and esophageal ulcers were the most commonly reported abnormalities. Failure to take alendronate with sufficient water as prescribed and lying down after taking the medication were associated with increased risk of esophageal complications.

Esophageal Perforation

The prescribing information for alendronate warns that esophageal perforation has occurred rarely in people taking this medication. Esophageal perforation (a hole in the esophagus) is a medical emergency characterized by intense pain under the breastbone. Difficulty swallowing, fever, chest pain and breathing difficulties develop as the chest cavity is contaminated by leakage from the esophagus.

Esophageal Stricture

Persistent or repeated episodes of esophagitis and esophageal ulcers due to alendronate use can lead to scarring of the esophagus. Scar tissue is stiff and contracts over time, making it unlike the normally elastic wall of the esophagus. An accumulation of scar tissue can cause an esophageal stricture, a rigid narrowing of the esophagus. Strictures typically cause difficult and painful swallowing, which can be severe enough to prevent adequate nutritional intake. Food that cannot pass through the stricture frequently comes back up into the mouth.

Osteonecrosis of the Jaw

Osteonecrosis of the jaw (ONJ) is a serious condition in which part of the jawbone dies. In 2005, reports associating ONJ with the use of bisphosphonates including alendronate led to the addition of a warning about ONJ in the prescribing information for Fosamax. In a 2010 study published in the "Journal of Oral and Maxillofacial Surgery," Dr. J. Lo and colleagues reported the prevalence of ONJ among people taking bisphosphonates (including alendronate) is approximately 1 in 1,000. Be sure your dentist is aware if you are taking alendronate, especially if you are planning dental surgery.