Alendronate

WHAT IS IT?

Alendronate (fosamax) is a bisphosphonate medication that is used to antagonize osteoclast. Bisphosphonates are pyrophosphate analogs that bind hydroxyapatite in bone. They are ultimately taken up by osteoclasts, at which point they inhibit their activity (and can induce apoptosis).   

Proposed mechanisms of bisphosphonate activity (source)
Proposed mechanisms of bisphosphonate activity (source)
WHEN DO WE USE IT? 

Osteoporosis, hypercalcemia, Paget disease of bone

WHEN DO WE AVOID USING IT?

Patients with esophageal abnormalities that delay emptying (such as achalasia)

HOW IS IT ADMINISTERED?

Administer tablet orally upon awakening with a full glass of plain water at least 30 minutes before first food, beverage, or other orally administered drug of the day. Excreted in the urine.

Source
Source
WHAT ARE THE SIDE EFFECTS/TOXICITY?

Corrosive esophagitis: patients should be advised to take with water and remain upright for 30 minutes after taking medication (to avoid any reflux).

Osteonecrosis of jaw is a possible outcome with bisphosphonate usage

Esophageal cancer is IMPLICATED however there are conflicting studies about this as of now.

ANYTHING ELSE TO KEEP IN MIND?

-dronate ending is specific to bisphosphonates

Half-life of this medication is > 10 years!

FURTHER READING

DynaMed

UpToDate

Page Updated: 02.23.2016