Alendronate
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Trade Name
Fosamax (primary brand name); generic alendronate sodium
Classification
Bisphosphonate; bone resorption inhibitor
Dosage/Route
- * Dosage: Tablets: 5 mg, 10 mg, 35 mg, 40 mg, 70 mg; Oral solution: 70 mg/75 mL
- * Route: Oral (PO)
Usual Dosage
- * Osteoporosis Treatment: 10 mg PO daily or 70 mg PO once weekly
- * Osteoporosis Prevention: 5 mg PO daily or 35 mg PO once weekly
- * Paget’s Disease: 40 mg PO daily for 6 months
- * Take first thing in AM, 30 min before food/drink
Mechanism of Action
Binds to hydroxyapatite in bone, inhibiting osteoclast activity and reducing bone resorption. Slows bone turnover, increasing bone density and preventing fractures in osteoporosis
Side Effects & Adverse Effects
- * Side Effects: Abdominal pain, dyspepsia, nausea, musculoskeletal pain
- * Adverse Effects:
- – Esophagitis/ulceration (irritation, chest pain; boxed warning)
- – Osteonecrosis of the jaw (ONJ) (rare; jaw pain, swelling)
- – Atypical femoral fractures (long-term use; thigh pain)
- – Hypocalcemia (rare; muscle spasms)
Nursing Management (Implications & Teachings)
- * Implications:
- – Ensure proper administration (see teachings); monitor adherence
- – Assess for GI symptoms (esophagitis) or jaw/thigh pain
- – Check calcium/vitamin D status (supplement if low, not concurrently)
- – Avoid in esophageal stricture or renal impairment (CrCl <35 mL/min)
- * Teachings:
- – Take first thing in AM with 6-8 oz plain water, 30 min before eating/drinking
- – Sit/stand upright for 30 min after dose (no lying down)
- – Report chest pain, difficulty swallowing, or new bone pain
- – Don’t chew/crush; skip dose if timing missed
Indication for This Patient
- * Osteoporosis: Treatment (postmenopausal, glucocorticoid-induced, men) or prevention (postmenopausal women)
- * Paget’s disease of bone: Reduces bone turnover
Time
- * Timing: Daily (AM) or weekly (same day each week)
- * Onset: Bone density increase in months; fracture risk reduction over years
- * Duration: Long-term (reassess after 3-5 years)
