Alendronate adverse effects

Several studies have evaluated the long-term efficacy and safety of bisphosphonates in postmenopausal women. One study evaluated the use of alendronate over a 10-year period and found no difference in adverse effects between women who received alendronate for 10 years and women who discontinued alendronate after 5 years. Women who discontinued alendronate after 5 years continued to experience sustained increases in bone mineral density compared with baseline values and a reduction... 

Since both raloxifene and the non-hormonal drug alendronate reduce the incidence of osteoporotic fractures in postmenopausal women it is relevant to determine which approach is better tolerated and thus most likely to promote long-term adherence to therapy. Adverse effects and compliance have been studied in a direct randomized comparison over 12 months in 902 women attending 154 treatment centres in Spain (21). They took either raloxifene 60 mg/day or alendronate 10 mg/day. Those who took raloxifene reported significantly better compliance than those who took alendronate more patients discontinued alendronate prematurely than raloxifene (26% versus 16%. The main reason for premature discontinuation was adverse reactions, particularly gastrointestinal reactions (9.9% with alendronate, 3.4% with raloxifene). 

B. Adverse effects These include diarrhea, nausea, and abdominal pain. Alendronate, etidronate, and risedronate are associated with... 

Most patients prefer once-weekly bisphosphonate administration (see Table 88-6). This dosing schedule lowers G1 tract drug exposure. Because the turnover rate of the cells lining the G1 tract is about 5 days, any cells damaged during drug exposure are theoretically replaced before the next week s dose is taken. Once-weekly alendronate administration achieved similar BMD results, had similar GI adverse effects, and did not impair mineralization, compared with daily doses of 10 mg. ... 

Alendronate is commonly known to be associated with oesophageal adverse effects, and there are strict dosing instructions to minimise this risk. It may also cause local irritation of the stomach, although its potential to cause gastric ulcers is not considered established. ... 

Uses Rx prevent osteoporosis male female, Rx steroid-induced osteoporosis, Paget Dz Action -1- N1 abnormal bone resorption Dose Osteoporosis Rx 10 mg/d PO or 70 mg qwk Fosamax plus D 1 tab qwk Steroid-induced osteoporosis Rx 5 mg/d PO Prevention 5 mg/d PO or 35 mg qwk Paget Dz 40 mg/d PO Caution [C, ] Not OK if CrCl <35 mLAnin, w/ NSAID use Contra Esophageal anomalies, inability to sit/stand upright for 30 min, X Ca Disp Tabs, soln SE GI disturbances, esophageal irritation, HA, pain, jaw osteonecrosis (w/ dental procedures, chemo) Interactions -1- Absorption W7 antacids, Ca supls, Fe, food T risk of upper GI bleed W/ ASA NSAIDs EMS May cause cardiac conduction abnormalities d/t T Ca T risk of jaw fractures esp w/ dental procedures OD May cause hypocalcemia and adverse upper-GI effects milk or antacids can be given to bind alendronate... 

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