Osteofos (Alendronic Acid (Alendronate Sodium))
Also sold as: Osteofos, Fosamax, Alenost, Bonmax, Aledromax
Pregnancy
Cat C
Lactation
Avoid
Schedule
H
Forms
Tablet 10mg (daily) +2
Indications
- Postmenopausal osteoporosis (reduces vertebral and hip fracture risk — most evidence base)
- Male osteoporosis
- Glucocorticoid-induced osteoporosis (prevention and treatment)
- Paget's disease of bone (40 mg daily for 6 months)
Adult Dosing
Osteoporosis (postmenopausal/male)
70 mg PO once weekly (preferred for compliance) OR 10 mg PO once daily
Take on an empty stomach (30 minutes before first food/drink/medication). Take with full glass of plain water (not juice or coffee). REMAIN UPRIGHT for at least 30 minutes after. Do NOT lie down.
Glucocorticoid-induced osteoporosis
5 mg once daily OR 35 mg once weekly (postmenopausal women not on HRT: 10 mg/70 mg)
Paget's disease
40 mg PO once daily for 6 months
Pediatric Dosing
IV pamidronate used more often for paediatric bisphosphonate therapy
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl < 35 mL/min | NOT RECOMMENDED — bisphosphonates accumulate in bone; risk of renal toxicity; use alternative if eGFR < 35 mL/min (e.g., consider denosumab — safe in renal impairment) |
Hepatic Adjustment
No dose adjustment required — not hepatically metabolised
Pregnancy & Lactation
Pregnancy: Category C
AVOID in pregnancy — bisphosphonates incorporate into fetal skeleton (long half-life in bone — years). Teratogenicity in animals (skeletal malformations). Women of childbearing potential: discuss with specialist before starting. If inadvertently pregnant: neonatal hypocalcaemia possible.
Lactation: Avoid
Not established — do not use in breastfeeding. Bisphosphonates have very long bone half-life.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Calcium supplements, antacids, iron | Chelation — dramatically reduce alendronate absorption. Take alendronate 30 min before calcium/antacids/iron — or 2 hours after. | Major |
| Aspirin / NSAIDs | Additive upper GI irritation risk — use with caution; ensure strict upright posture protocol | Moderate |
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Side Effects
Common
- Oesophageal irritation / oesophagitis (if taken incorrectly — most common serious side effect)
- Nausea, dyspepsia, abdominal pain
- Musculoskeletal pain (diffuse — bones, joints, muscles)
- Headache
- Dizziness
Serious / Discontinue If
- Oesophageal ulceration/erosion/stricture (if not taken with adequate water while remaining upright)
- Osteonecrosis of the jaw (ONJ — rare; risk: IV bisphosphonates >> oral; dental extraction without adequate healing; cancer patients on high-dose; poor dentition)
- Atypical femoral fractures (subtrochanteric/diaphyseal — bilateral; after > 5 years of use; thigh pain prodrome)
- Severe musculoskeletal pain (rare — may be incapacitating; stop drug)
- Uveitis, scleritis (rare)
- Hypocalcaemia (pre-existing vitamin D/calcium deficiency — give supplements before starting)
Contraindications
- Oesophageal abnormalities (stricture, achalasia, severe oesophagitis)
- Inability to remain upright for 30 minutes
- CrCl < 35 mL/min
- Hypocalcaemia (correct first)
- Hypersensitivity to bisphosphonates
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Osteofos 70mg | Cipla | 4 tab (4 weeks) ₹165 |
| Fosamax 70mg | MSD | 4 tab ₹325 |
| Alenost 70mg | Sun Pharma | 4 tab ₹145 |
| Bonmax 70mg | Glenmark | 4 tab ₹155 |
Monitoring Required
- BMD (DEXA — at baseline, then every 1–2 years; review at 5 years whether to continue or take drug holiday)
- Serum calcium and vitamin D (before starting — correct deficiency; then annually)
- Renal function (eGFR — before starting)
- Dental assessment (before starting — treat dental disease first; maintain good dental hygiene)
- Thigh/groin pain (atypical femur fracture prodrome — bilateral X-ray)
Patient Counseling Points
- ⚠️ MUST take on a completely empty stomach: first thing in the morning before any food, drink (except water), or other medications
- ⚠️ Take with a full large glass of plain water (200–250 mL) — not juice, coffee, or mineral water
- ⚠️ Remain sitting upright or standing for at LEAST 30 minutes after taking — absolutely no lying down; severe oesophageal damage otherwise
- Weekly tablet: take on the same day each week — pick a day you'll remember (e.g., Sunday)
- Take calcium and vitamin D supplements at a different time of day (not together with alendronate)
- Report any new thigh or groin pain (both sides) — rare but serious stress fracture signal
- Good dental hygiene and regular dentist visits are important — inform your dentist you are on alendronate before any tooth extractions
- After 5 years: discuss with your doctor whether to take a "drug holiday" — ongoing need varies by fracture risk
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Clinically reviewed by: Dr. Anand Prabhakar, DM (Nephrology), Consultant Nephrologist
Last reviewed: 2026-04-01
References
- AACE Osteoporosis Guidelines 2020
- IOF Osteoporosis Guidelines 2022
- BNF — Alendronic Acid
- FDA Bisphosphonate Safety Communications
- ECTS European Consensus on ONJ 2019