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Alendronic acid is the most common bisphosphonate for osteoporosis. It slows bone loss and lowers the risk of bone fractures – as long as the strict intake ritual with the weekly tablet is followed exactly.
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Never stop alendronic acid on your own. Osteoporosis runs without symptoms for a long time – stopping without medical advice increases the risk of bone fractures. Always discuss any changes with your practice. Alendronic acid (brand name Fosamax®) is the most frequently prescribed bisphosphonate for osteoporosis. It slows bone loss, makes the bones more stable again and lowers the risk of vertebral and hip fractures. It is usually taken as a weekly tablet – with a clear intake ritual that protects the oesophagus.
| Property | Details |
|---|---|
| Active ingredient | Alendronic acid (alendronate) |
| Brand name | Fosamax® |
| ATC code | M05BA04 |
| Drug class | Bisphosphonate (bone metabolism) |
| Formulation | Tablets 10 mg (daily) & 70 mg (weekly) |
| Intake | In the morning on an empty stomach, with a large glass of tap water |
| Standard dose | 70 mg once/week |
| Prescription required | Yes |
| Special note | Stay upright afterwards for at least 30 minutes, on an empty stomach |
Bones are living tissue and are constantly being remodelled: special cells, the osteoclasts, break down old bone substance, while other cells build up new bone. In osteoporosis this balance falls out of step – more is broken down than built up, the bone becomes porous and breaks more easily.
Alendronic acid deposits exactly where bone is being broken down and inhibits the activity of the osteoclasts. The excessive breakdown is slowed and bone density increases again over time. Studies show that this makes vertebral and hip fractures in particular less frequent. The effect builds up slowly over months – which is why reliable, long-term intake is so important, even if you feel nothing of the osteoporosis itself.
The most common option is the weekly 70 mg tablet, taken once a week always on the same day of the week. Alternatively, there is a daily 10 mg tablet. The big advantage of the weekly tablet: the elaborate intake ritual is only needed once a week.
| Situation | Dose |
|---|---|
| Standard (weekly tablet) | 70 mg once/week |
| Daily intake | 10 mg once/day |
| Time of intake | In the morning, on an empty stomach, as the first thing of the day |
| Fluid | 1 large glass (approx. 200 ml) of tap water |
If you forget the weekly tablet once, take it on the morning after you notice – but never two tablets on the same day. Afterwards you return to your original day of the week. What generally applies to a missed dose is explained in the guide Forgotten medication.
Alendronic acid is absorbed by the body only very poorly and can irritate the oesophagus. The strict intake ritual ensures that the active ingredient works and the oesophagus stays protected. Follow these steps exactly:
| Step | What you do |
|---|---|
| 1. Morning, empty stomach | Right after getting up, before the first food, drink or other tablets. |
| 2. Large glass of tap water | Swallow the tablet whole with a full glass (approx. 200 ml) of tap water – no mineral water, no coffee, no milk, no juice. |
| 3. Stay upright | Sit or stand for at least 30 minutes – do not lie down again. |
| 4. Take nothing | During these 30 minutes eat nothing, drink nothing else and take no other medicines. |
| 5. Breakfast & the rest | After 30 minutes have your normal breakfast and take all the other tablets (including calcium). |
brite reminds you of your fixed intake day and guides you through the 30-minute ritual.
Alendronic acid can only work if there are enough building blocks for the bone. That is why an adequate supply of vitamin D and calcium is the basis of every osteoporosis therapy. Vitamin D ensures that calcium is absorbed from the gut and built into the bone.
Many patients additionally take a calcium supplement and often also magnesium. Important: these minerals bind alendronic acid and therefore must not be taken together with the weekly tablet – at the earliest after the 30-minute ritual, better at a different time of day.
The most common side effects affect the gastrointestinal tract and the oesophagus – especially when the intake ritual is not followed. They are usually mild, but in rare cases serious.
| Side effect | Frequency | What to do? |
|---|---|---|
| Heartburn, stomach pressure, nausea | Common | Check the intake ritual closely; raise it with your doctor |
| Muscle, bone or joint pain | Common | Usually temporary; if it persists, get it checked |
| Irritation of the oesophagus, difficulty swallowing | Uncommon | Stop taking it and get it checked by a doctor |
| Osteonecrosis of the jaw | Very rare | Watch for tooth/jaw pain, inform your dentist |
Osteonecrosis of the jaw is a very rare but serious side effect in which jaw bone can die. It mainly affects people on high-dose bisphosphonates (e.g. in cancer therapy) and occurs only extremely rarely at the osteoporosis dose. If possible, visit the dentist before starting therapy and tell your dentist that you are taking a bisphosphonate.
The most important "interactions" of alendronic acid are really absorption problems: anything containing calcium or other minerals prevents the active ingredient from being absorbed. Check your combinations in the interaction check.
| Substance / medicine | Interaction | Recommendation |
|---|---|---|
| Calcium, magnesium, iron, antacids | Absorption of alendronic acid is blocked | Space it out – only after the 30-minute ritual |
| Mineral water, milk, coffee, juice | Bind the active ingredient in the stomach | Take only with tap water |
| NSAIDs (ibuprofen, diclofenac) | Increased risk of gastrointestinal irritation | Only after consulting your doctor |
| Other tablets in the morning | Absorption disrupted | Take only after 30 minutes |
With brite you have your weekly tablet, vitamin D and calcium clearly laid out in your medication plan.
