Fosamax is a brand name for alendronate, a medication in the bisphosphonate drug group used for the treatment and prevention of osteoporosis and other degenerative bone diseases. Bone is continuously renewed, a process that requires balance between old bone reabsorption and new bone deposition. Among postmenopausal women and older men, bone reabsorption outpaces deposition. Alendronate inhibits bone reabsorption, tipping the balance in favor of bone deposition. While alendronate is typically well tolerated, certain risks occur with use of the drug.
Esophageal Irritation
The U.S. Food and Drug Administration-approved prescribing information warns of a risk for irritation of the esophagus associated with oral administration of alendronate. Irritation may manifest as esophageal inflammation, or esophagitis, esophageal ulcers or, rarely, a hole in the esophagus. Symptoms that may indicate the development of esophageal irritation include heartburn, pain behind the breastbone and painful or difficult swallowing. People with underlying gastrointestinal disorders such as peptic ulcer disease, gastritis, Barrett's esophagus or another esophageal disorder may be at increased risk for alendronate-induced esophageal irritation.
Severe Muscle, Joint and Bone Pain
In 2008, the U.S. Food and Drug Administration issued an advisory to health-care professionals warning of the possibility of severe muscle, joint and bone pain in people taking prescription bisphosphonates, including alendronate. The advisory notes that pain may develop any time after beginning therapy with a bisphosphonate. Among those who experience this side effect, pain may resolve quickly or abate slowly upon discontinuation of alendronate. In rare instances, residual pain may persist. Notably, severe muscle, joint and bone pain associated with use of alendronate or another bisphosphonate occurs in the absence of fever and chills.
Osteonecrosis of the Jaw
Osteonecrosis of the jaw is a rare but serious possible side effect of treatment with alendronate and other bisphosphonates. This condition involves the localized death of bone within the jaw. In a 2009 research article published in "The Journal of the American Dental Association," Dr. Parish Sedghizadeh and colleagues found that osteonecrosis of the jaw may occur in people on long-term oral therapy with alendronate, most commonly developing after a tooth extraction or in the presence of gum erosion due to poorly fitting dentures. The authors suggest that the occurrence of osteonecrosis of the jaw associated with oral bisphosphonate therapy may be higher than previously suspected, particularly in patients on treatment for an extended period. The drug is incorporated into bone where it remains for a prolonged period. The authors posit that accumulation of the drug in bone after extended treatment may increase the risk for osteonecrosis of the jaw. Good oral hygiene may help prevent the occurrence of osteonecrosis of the jaw associated with alendronate and other bisphosphonate treatment.
References
- U.S. Food and Drug Administration: Fosamax Prescribing Information
- U.S. Food and Drug Administration: Information for Healthcare Professionals: Bisphosphonates (marketed as Actonel, Actonel+Ca, Aredia, Boniva, Didronel, Fosamax, Fosamax+D, Reclast, Skelid, and Zometa)
- "The Journal of the American Dental Association"; Oral Bisphosphonate Use and the Prevalence of Osteonecrosis of the Jaw, an Institutional Inquiry; Parish P. Sedghizadeh, D.D.S., M.S., et al.; January 2009
- Mayo Clinic: Alendronate (Oral Route)
- National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center: Oral Health and Bone Disease
