How Is Fosamax Prescribed?
Fosamax, whose generic name is alendronate, is a bisphosphonate medication prescribed for treatment and prevention of osteoporosis. Fosamax stops bone cells from being removed from bone by osteoclasts, which break down older bone so new bone can grow. In people with osteoporosis, new bone growth is slowed. Removal of older bone by osteoclasts means bones density decreases and the risk of fracture is higher.
Recommendations
Fosamax is taken orally by people who have been diagnosed with osteoporosis or those who have osteopenia (bone loss not yet at the level of osteoporosis) with risk factors for developing osteoporosis. People in a high-risk category are those taking steroid medications, women who are thin, Caucasians or Asians, or women with a family history of osteoporosis. Fosamax is also prescribed for people with Paget's disease.
Dosing
Dosing of Fosamax depends on the cause and degree of disease, but current recommendations are:
For treatment of osteoporosis in postmenopausal women: 70 mg once a week, or 10 mg a day.
To prevent osteoporosis in postmenopausal women at risk: 35 mg a week, or 5 mg a day.
To treat and prevent osteoporosis in men and women taking glucorticosteroids: 5 mg a day. Women taking glucorticosteroids who are not also taking estrogen replacement therapy, 10 mg a day.
Fosamax must be taken on an empty stomach, first thing in the morning, with a full glass of water only, and the patient must remain upright (not lying down) for half an hour after taking the pill.
Side Effects
Gastrointestinal problems such as abdominal pain, acid reflux, nausea, diarrhea and stomach ulcers are the most common side effects of Fosamax. Severe joint pain has also been reported. Rare side effects include allergic reaction, rash, dizziness and uveitis.
Serious side effects of Fosamax treatment include osteonecrosis of the jaw and problems with the esophagus, the tube that leads from the mouth to the stomach. Osteonecrosis is the death of bone in the jaw; most patients with this complication have been those receiving intravenous Fosamax for cancer treatment, but cases have also occurred in people taking the drug orally for osteoporosis. Infection, anemia, poor oral hygiene and those undergoing dental treatment are at higher risk for this complication.
Esophageal erosion and esophageal cancers have been reported in people taking Fosamax orally, according to a letter written by B. Abrahamsen in the New England Journal of Medicine. These complications are more likely to occur in people who don't take the pill with enough water or who don't remain upright for 30 minutes after taking the pill.
