Fosamax

What Fosamax is for

Fosamax is a weekly tablet of alendronate, part of the bisphosphonate family of bone medicines. It is used for osteoporosis — bones that have thinned and break more easily — in women after the menopause and in men, and for the bone loss that follows long courses of steroid tablets such as prednisolone. It also treats Paget's disease of bone, where bone is rebuilt in a disorganised way and can become painful or misshapen. Alendronate lowers the chance of spine and hip fractures, steadying the condition rather than curing it: scans usually show a change in bone density after three months or more, not weeks.

Why the tablet is taken this way

Bone is torn down and rebuilt all the time, and alendronate attaches to the bone surface where that turnover is busiest. There it holds back the osteoclasts, the cells that clear away worn-out bone, so the rebuilding cells can catch up and density and strength creep upward over months. Very little of any alendronate tablet is absorbed even on an empty stomach, which is why the morning routine below is not optional.

Your Fosamax morning

Choose a day of the week you will remember and keep to it. Straight after getting up, before any food or drink, swallow one tablet whole with a full glass of plain water. Tea, coffee, juice, milk and fizzy water all cut down how much alendronate gets through. Then stay sitting or standing for half an hour; breakfast, other drinks and any other tablets wait until that half hour is up. Lying back down is the mistake to avoid, because a tablet resting against the oesophagus (the tube from mouth to stomach) can burn it. If your day slips your mind, take one tablet the next morning and carry on with your usual day — never two in one day.

Side effects

Most complaints are digestive: heartburn, indigestion, stomach ache, nausea, wind, and either constipation or diarrhoea. Headaches and aching muscles, joints or bones are reported as well. Pain on swallowing, or a new burning behind the breastbone, means the oesophagus is irritated and should not be put up with. Rarer effects include unusual pain in the thigh or groin, jaw pain or a tooth socket slow to heal, and low blood calcium. Anti-inflammatory painkillers such as ibuprofen or naproxen can add to the stomach irritation.

Keep these away from your dose

Calcium supplements, antacids, iron tablets and mineral-containing multivitamins bind alendronate in the gut, so leave at least half an hour between them and the tablet; many people take their calcium with a later meal instead. Store the sealed blisters somewhere cool and dry, out of direct sun.