Weekly Doses and Good Posture: 8 Pharmacist Tips for Taking Alendronate (Fosamax)

We often take our bone health for granted. That is, until something such as osteoporosis helps us realize how important it is. Osteoporosis is a silent health condition that increases the likelihood of bone fractures. It often goes undetected unless you get screened by a healthcare professional.

You may receive a prescription to take alendronate (Fosamax) for better bone health. It helps prevent and treat osteoporosis and reduces the risk of bone fractures. It slows the process of bone breakdown, helping you maintain stronger bones. This is especially important for people at higher risk of fractures.

To maximize the effectiveness of your medication, there are several things to keep in mind. Let’s discuss eight tips to help you take alendronate safely and effectively.

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1. You can take alendronate once a week

Some people take alendronate once a day. But taking a medication every day can feel like a chore. You have the option to take alendronate once a week for most types of osteoporosis; its effects can last awhile. But it’s recommended to take a lower dose of alendronate daily (rather than weekly) if you have osteoporosis due to corticosteroid use. Your prescriber will tell you how often you should take the medication, so be sure to follow their instructions.

Alendronate comes in multiple forms, including tablets and an oral solution. Whether you take alendronate daily or weekly, drink a full glass of water (8 oz) after taking the tablets. You need to drink only 2 oz of water after taking a dose of the oral solution.

Don’t double up on doses if you forget to take a dose of weekly alendronate. Take your weekly alendronate dose the next morning, then return to your regular day.

2. Stay upright shortly after each dose

One of the most important things to remember with alendronate is that you should stay upright for at least 30 minutes after taking a dose. This means standing, sitting up straight, or walking around.

This is because alendronate can irritate the lining of your esophagus, the tube that carries food from your mouth to your stomach. Lying down too soon after taking alendronate increases the risk of upper digestive system side effects. This can lead to discomfort, heartburn, or more serious complications, such as ulcers.

This time frame applies to another rule too. Avoid eating or drinking anything other than water for 30 minutes after every alendronate dose. This helps your body absorb the medication properly. Other beverages, such as milk, coffee, and orange juice, can interfere with how you absorb alendronate.

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3. Prioritize calcium and vitamin D intake

Your body needs enough calcium and vitamin D to build and maintain strong bones — even if you’re taking alendronate. Alendronate can’t do its job effectively unless you consume an adequate amount of these nutrients. Vitamin D helps your body absorb calcium, and calcium helps build strong bones.

It's important to meet the recommended daily intake of these nutrients. For most adults, that means around 1,000 mg to 1,200 mg of calcium and 600 IU to 800 IU of vitamin D per day. You can get calcium from foods like dairy products, leafy-green vegetables, and orange juice. Milk, fatty fish (like salmon), and sunlight are all great sources of vitamin D.

If you don’t get enough calcium or vitamin D in your diet, a healthcare professional may recommend taking calcium and vitamin D supplements.

4. You can manage certain side effects on your own

Most of alendronate’s side effects are mild. They’re manageable at home and often go away over time.

You may experience mild digestive system symptoms, such as nausea, heartburn, or constipation. Staying upright after taking alendronate helps reduce the risk of nausea and heartburn. Drinking plenty of water and eating a high-fiber diet can help prevent constipation. You can also ask your pharmacist for over-the-counter (OTC) constipation and heartburn medication recommendations.

You may also experience muscle pain, joint pain, or headaches. They can usually be managed with OTC pain relievers, such as acetaminophen (Tylenol), or various home remedies. Tell a healthcare professional if your pain doesn’t go away or worsens over time.

5. Some side effects warrant a prompt call to your healthcare team

Some alendronate side effects may need medical attention. One serious alendronate side effect is osteonecrosis of the jaw (ONJ). This is a rare condition in which your jawbone starts to weaken and break down.

ONJ is more likely in people undergoing dental surgery or with poor oral hygiene. ONJ symptoms include jaw pain, swelling, and loose teeth. Contact a healthcare professional right away if you have any of these symptoms.

Other serious risks may include:

• Esophageal ulcers

• Severe bone, joint, or muscle pain

• Vision problems

• Higher risk of femur fractures

• Allergic reactions (hives, itching, trouble breathing)

As with any medication, it’s important to report any unusual symptoms to your healthcare team as soon as possible.

6. Certain interactions are possible

It’s best to separate alendronate from foods and other medications by at least 30 minutes. This is so your body can absorb the medication without the effects of an interaction.

Calcium supplements are important for building strong bones. You should take them if a healthcare professional recommends it. But do not take them at the same time as alendronate. If you do, alendronate likely won’t work as effectively to increase your bone density. Wait at least 30 minutes before taking calcium supplements. The same goes for other minerals, such as magnesium, iron, and multivitamins containing them.

Antacids can also decrease alendronate absorption. You should hold off on taking these for 30 minutes after a dose. Ask a pharmacist about heartburn treatments that don’t interact with alendronate, such as famotidine (Pepcid).

If you’re experiencing pain, keep in mind that aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk of digestive side effects when paired with alendronate. A medication like acetaminophen may be better.

These interactions can be hard to keep track of. A healthcare professional can recommend treatments that don’t interact with your bone medication. Make sure to give them an updated list of medications and supplements that you take.

7. Pregnant? Don’t take alendronate

Alendronate isn’t recommended during pregnancy. It’s important to discuss alternative osteoporosis treatments with a healthcare professional if you’re planning on becoming pregnant or are pregnant.

We don’t have extensive information on how alendronate affects fetuses. But limited case reports show negative effects on fetuses when they’re exposed to alendronate. This includes low levels of calcium in the blood, low birth weight, and other side effects. High alendronate doses also affected fetal weight, tooth growth, and skeleton development in animal studies.

Breastfeeding while taking alendronate isn’t recommended, either. We don’t know if alendronate passes into breast milk. But this could affect a nursing infant’s bone development.

8. Listen to your prescriber’s instructions regarding duration of use

Many people take alendronate for several years at a time. But it usually isn’t taken forever. A healthcare professional should regularly reevaluate whether alendronate is still the best osteoporosis treatment for you. This is because long-term alendronate use (beyond 5 to 7 years) may not offer additional benefits.

A healthcare professional may recommend stopping alendronate temporarily after a few years. This is called a drug holiday. They may also recommend stopping alendronate entirely.

But don’t stop taking alendronate unless you’ve been instructed to do so. Stopping treatment too early could increase your risk of fractures due to bone loss.

How to save on alendronate

There are ways to save on alendronate, which is available as a brand-name and generic medication. A 3-month supply of generic alendronate 70 mg costs as low as $13.77 at certain pharmacies with a free GoodRx discount.

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Written by:

Mandeep Sohal, PharmD

Mandeep Sohal, PharmD, has more than 7 years of experience in the pharmaceutical industry and is licensed in California. In his career, he’s had experience with specialty pharmacy, community pharmacy, pharmacy benefit management, and pharmaceutical manufacturers.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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