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Doctors' Answers to "Frequently Asked Questions" - Fosamax

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 07/23/2000]
Question: I have been taking Fosamax for about 4 years for osteoporosis (severe) - 10 mg daily. ( I have not had medical insurance for almost 2 years, so have had to buy my medication out of the country, a German brand of sodium alendronate at 1/3 the cost as that sold in US, and have not had a recent bone density.) I have recently heard that a new 70 mg tablet which can be taken once per week will be available at the end of the year. Is it possible to take 7 of the 10 mg tablets at one time and get the same effect? Does this mean that the body retains the excess fosamax and utilizes it all, like a time-release vitamin? Please explain! Thank you.

Answer: The higher dosage is being utilized to lower the gi toxicity and make it more convenient. I have not seen controlled studies on it yet, but the company must have filed them to get the approval from the FDA. You will get the convenience of taking 7 at once, whether you will get the gi problems is less clear.

[posted 06/24/2000]
Question: Recently 5mg Fosamax has been prescribed for me (age:44 premenopausal). I take alot of Naproxen for menstrual cramp
relief, is this combination going to be a problem?

Answer: Both can irritate the stomach/esophagus. But, you won't know until you try. Many patients have no gi problems at all on Fosamax, but this would be the risk.

[posted 06/4/2000]
Question: My mother is treated with Fosamax for her osteoporosis. she is travelling to the far east. Can she take the drug with mineral water (it is not recommended to drink tap water there), and if not why?
Is it preferable not to take fosmax during that period?

Answer: A couple of weeks would not usually matter with a long term drug like Fosamax. I'm not aware of a problem with mineral water and any bottled water should suffice.

[posted 06/2/2000]
Question: I would like to know if you can take fosomax with a hiatus hernia ,

Answer: Sure, but watch closely for gi irritation. If you get heartburn or indigestion, let your md know.

[posted 05/25/2000]
Question: I have just been advised that a bone density scan showed that I have early signs of oesteoparosis. I have had no problems (just happened that I mentioned to doc during annual physical that I had fallen and fractured my patella). Anyway, he scripted Fosonax 10 with another bone test in 2 years. To me that means long term on this medication. I read through the FAQ section and understand some of the possible side effects. My normal regimine is to take vitamins, calcium, and a meta boost first thing in the a.m. Can any vitamins, etc. taken along with Fosonax deter from its absorbtion. (I recognize no food) Also how common are the side affects?

Answer: Whether you need this medication would depend on the severity of the bone loss. However, usually there are no side effects other than gastro-intestinal(heart burn, indigestion and the like). I'd try it and see since it is the best available drug currently for treatment of osteoporosis. If taken as directed, it will not affect the other drugs.

[posted 04/6/2000]
Question: I am a 50 year old female, post-menopausal. My recent dexascan has shown that my osteoporosis has advanced although I have followed a strict regimen of Fosamex (10mg), calcium supplements, no smoking and increased exercise. What other treatments may be available?

Answer: Increase the Fosamax to 20 mg this usually works if you don't have gi toxicity. Also, addition of miacalcin to the current dosage of Fosamax may be helpful, but not researched currently.

[posted 03/20/2000]
Question: I heard that a higher strength dosage of Fosamax can be taken twice a week instead of a lower strength daily. I have had an aortic artificical valve replacement and take coumadin. Is it okay to take Fosamax twice a week instead of one a day at the lower strength.

Answer: You would be better off taking a daily dosage in terms of the coumadin. It is changes that cause problems with coumadin not steady state dosing. You can take the twice a week dosage, but it is not clear currently which is the best option for long term prevention. The daily dosage has been studied extensively, the twice a week is the new kid on the block. In your case, it will be much safer to take it daily.

[posted 03/10/2000]
Question: Does early menopause(46) combined with infertility problems
(did conceive at 36) along with hypothyroidism and recently
diagnose osteoporois suggest any underlying condition?
My doctor prescribed fosomax for osteoporosis but wants me to
remain on prempro Is this overkill?
The fosomax prescription says wait 1/2 hr to eat or drink
after taking the drug, yet I just read some info that says 2
hrs are needed for maximum absorption after taking fosomax
which is correct?

Answer: Forty six is not too early, it would depend a lot on your mother's age of menopause since it does run in families. However, the pituitary would potentially control both. If your TSH has ever been up, the pituitary is ok(at least as far as the thyroid is concerned). As to the osteoporosis, it would depend a lot on the initial bone densities. Most would prefer that you start above the 50% percentile since you are so young. What are your densities and T scores? Thirty minutes is the usual recommendation.

[posted 02/26/2000]
Question: I have had a parathyroidectomy due to hypercalcemia, and my calcium level is still about 10.6

Recent bone density shows osteop. in hip- but can't take calcium. Am almost 50, no where near menopause, otherwise in good health. Dr. has suggested Fosomax, but method of intake and side effects, together with info stating that this is a medication for post-menopausal women, prevent me from starting. Suggestions?

Answer: If your calcium level is still up, I would ensure that all the affected parathyroid glands have been removed. A common problem is to miss one since they are so difficult to locate in the neck. In the meantime, Fosamax will work fine and should be one of your options until you get this fixed correctly. We use it for any type of calcium losing osteoporosis(like yours).

[posted 02/5/2000]
Question: I have been taking Fosomax for 4 years to treat osteopenia. The first 3 years showed steady, but small, improvement. This year, I had a 5.5% loss in my hip. I have 3 related questions:
1) Can Fosomax lose its effectiveness over time?
2) What is the new information about Lipitor showing an improvement in bone density?
3) Can I ask my endocrinologist to switch me to Lipitor (or any other drug that works better than Fosomax)?
Thank you, Deborah Martin

Answer: Fosamax will not lose it's effectiveness but it is very hard to absorb. Ensure you are following the directions very closely(take it first thing in the morning after you arise with no other food or medication for at least 30 minutes). Increasing the dosage is an option if you are taking it correctly. Lipitor is for cholesterol and would have no effect on osteopenia that I am aware of. Lastly, ensure that some other metabolic issue has not intervened. That is, check your serum PTH, Calcium, Vitamin D levels and thyroid levels. These are all other metabolic issues that can cause bone loss unrelated to the basic underlying osteopenia.

[posted 11/13/1999]
Question: I have been taking fosamax and evista since March with no side effects except my knees are bothering me very much. It used to be just one knee, now it is both. I have trouble getting up with much discomfort. Could it be a result of the drugs that I am taking?

Answer: Wouldn't think so, but a drug holiday of 2-3 weeks would answer your question.

[posted 10/30/1999]
Question: I have been taking 5mg of fosamax for 10 months due to a bone density study. I have just been diagnosed with mitral valve prolapse and dilatation of vasalvas of the aorta. Are there any studies that would indicate fosamax could cause these cardiac problems? Thank you.

Answer: Not that I'm aware of, you could check with the scientific department of Merck 800-672-6372, they will have all the scientific research on the drug including solo reports.

[posted 10/16/1999]
Question: Im a 64 y.o. male with osteopenia. I have been tested for testosterone, parathyroid, calcium etc. and all are normal. Basically I have the problem but no cause. I am taking Fosamax. Question..what else causes such a condition in a man and does Fosamax work in a man? Incidentally, I take no oral steroids.

Answer: Have you had your vitamin D levels checked? This is done by checking 25OHVitamin D or 1,25OHVitamin D levels. Also, a 24 hour urine for calcium excretion is necessary-high levels of "leakage" can be blocked with small doses of thiazide diuretics.

[posted 08/18/1999]
Question: I have been prescribed Fosamax because my bone scan came back less than what it should be for my age. I read somewhere that some patients take the drug in the afternoon instead of first thing in the morning. Due to my irregular sleeping times due to my job I want to know what constitutes an empty stomach? If I need to take the medication in the afternoon how may hours after eating or drinking anything other than water should I take the medication?

Answer: Usually no intake for four or five hours. I have patients that take it in the late afternoon-ensuring that they take in nothing but water since lunch.

Fosamax [posted 1/13/99]
Question: I am trying to find information on this prescription medication, i.e., applications, side effects, etc.

Answer: Check the FAQ section. Fosamax is a drug, which is used to improve bone density. It is poorly absorbed and is best taken on an empty stomach with water. Major side effects are GI, nausea, esophageal ulcers, gastritis, etc. It works pretty well if it gets absorbed. If not, it is pretty worthless. GI problems are the limiting factor in most patients. In addition to osteoporosis, we use it to treat Paget's Disease.

Fosamax [posted 1/8/99]
Question: I am suffering mouth pain and bleeding gums after taking fosamax. The tablet was taken as directed. Do you know of fosamax causing any mouth problems?

Answer: No.

Fosamax [posted 1/7/99]
Question: I am 60 years old and have been on Fosamax for 6 months now. I have not changed my diet or activities, but gained 15 pounds and get a bloated feeling a lot. Could this be a result of Fosamax? I take Fosamax due to the results of my bone density test and a couple fractures over the past year.

Answer: Bloating yes, weight gain no.

Fosamax & Metallic Taste    [posted 12/02/98]
Question: I have been taking Fosamax for a few weeks and have noticed a very metallic taste in my mouth in addition to experiencing a sort of "sick" feeling. Is a metallic taste a known side effect of this drug? Thank you for any information you can give me.

Answer:  Not usually, but, stop if for a week and see.

Fosamax & Difficulty Walking   [posted 11/17/98]
Question: My mother has been taking fosamax 10 mg. for the last 2 months. She has been complaining of severe hip/leg pain. She is only 56 years old and finds it difficult to get up/walk and drive. Her doctor has not taken any x-rays. I am very concerned. She said that this is one of the side effects of fosamax. She was doing better before she started taking this medication. Should she stop? Thanks for you help.

Not the fosamax, either arthritis of the hip or possibly a microfracture(the reason she is on the fosamax), either would need xrays and/or bone scan. Another possibility is bursitis of the hip. See a rheumatologist.

Fosamax & Gum Irritation [posted 11/6/98]
Question: I tried taking Fosamax, with no problem until the 4th day. My mouth began to ache like an absessed tooth and my gums began to bleed. The spot it ached the most was in an area where there was NO tooth, just a bridge. I stopped the drug, my mouth improved. I started the drug again, same thing, and painful! I quit again, called my dentist, he wanted to see me. I went today. He looked at the redness in the gum areas, especially where there was no tooth. He called the School of Dentistry and made an appointment for me to get a smear tomorrow. Have you heard of this happening before? I took the medicine as directed. 30 minutes before meals, sitting or standing, with lots & lots of water.

Answer: Esophageal and gastric irritation yes, oral no unless you keep it in your mouth a long period of time.

Take Fosamax With Water [posted 10/15/98]
Question: I have been taking Fosamax since it first came out and it has proved very beneficial to me as indicated by recent bone density test. I am 59 years old and take it in the morning on an empty stomach and have nothing else until 30 minutes have passed. I have been taking it with a large glass of sparkling spring water with lemon such as Poland Spring makes. Is this OK or must it be plain water with no flavoring or any carbonation to it?

Answer: They suggest just plain water. But, if your bone densities are improving, it is getting absorbed. The reason to take it on an empty stomach with only H20 is to enhance absorption(only about 10% of the drug is usually absorbed.)

Fosamax [posted 7/22/98]
Question: I recently saw ads promoting the drug Fosamax, but I'm not sure if this is generic name or brand. Is it an aide to persons with osteoarthritis or joint problems? Does it aide in the reversal of pain, swelling symptoms?

Answer: Fosamax is to treat osteoporosis, not osteoarthritis. Occasional patients with severe osteoporosis (thin bones) will have pain that the Fosamax will help. However, it will have little effect on joints or osteoarthritis.

Fosamax [posted 7/22/98]
Question: I am in urgent need of information regarding the drug Fosamax. I need to know the longest term study to date testing this drug, any long term side effects to date, and any known experimental problems with the testing of Fosamax.

Answer: You'll need to contact the company to get the latest research, especially unpublished data. The company is Merck 800-672-6372.

Question: I have been given Fosamax for my bone density (I have had seven stress fractures this year). I am a distance runner, 16 year old male, and I was wondering if Fosamax could affect my height (my epiphyses are open at the moment)? Is it okay to take Fosamax with a low-joule drink such as Diet Coke or is it best to stick with the water?

Answer: Why do you have osteoporosis? This is very unusual in one your age. I'd get this looked into prior to taking Fosamax. Having said that, it shouldn't affect your growth (but it’s never tested in children and teen-agers). Take it with water if you want to achieve maximum absorption. You need to see an osteoporosis specialist!

Fosamax and Palidronate
Question: Is there any benefit in taking these drugs for a person with osteogenesis imperfecta?

Answer: Not known. Probably not.

Question: My doctor sent me to a specialist who prescribed Fosamax about a year ago because I have an unexpectedly low bone density (determined by a bone scan, I believe it's called.) I am a 53 year old female. I have found the restrictions about taking Fosamax (no food several hours before, none for thirty minutes afterwards, no laying down for thirty minutes afterwards) difficult to follow because my life is so frenetic I am often up during the night, and therefore eating, etc. So I stopped taking it, since my understanding was that it would not be effective unless I met the various food conditions, plus laying down would cause esophageal irritation. I went back to the specialist for a checkup about a week ago, and my bone density had dropped again significantly during the year. I determined to try to take Fosamax again. However, now I am wondering if I could take it late in the afternoons instead of first thing in the mornings. Late in the afternoon I usually meet all the no food conditions, and would not be laying down for some time. I was also wondering if I had to take it at pretty much the same time each day, or if the morning one day, the afternoon the next, etc., would be okay, as a function of when I've been working and therefore eating.

Answer: As long as you take it on an empty stomach, with no other medications or food, it doesn't seem to matter when you take it. Many of my patients prefer late afternoon-- an hour or so before dinner.

Question: My 70 year old mother was put on Fosamax, and after a short time developed one of the side effects - an irritation in her esophagus. She stopped the drug, but now, three months later she is just as uncomfortable. She has seen three doctors and two gastrointerolists who say that there is nothing wrong with her. How long can this irritation last? What can she do to help with the discomfort for now?

Answer: Has she received any treatment? Usually H2 blockers(available over the counter) or treatment with prilosec or prevacid is initially prescribed. If this is unsuccessful, propulsid a motility agent) is commonly added. Possibly it is not her esophagus, but referred pain from her gall bladder or stomach. I would try treating with 300 mg of Zantac for a while and see what happens.

Question: My grandmother broke her lower spinal about a year ago. There is a drug called "Alendronate." I was asked to check out to see if it would help. In addition, what drugs can she take to help her heal faster and ease her pain?

Answer: Fosamax (alendronate sodium) is a recently released medication to aid in osteoporosis. Its function is to specifically inhibit the resorption of bone. The initial studies of this drug are promising since it is one of the few "non hormonal" drugs to achieve any improvement in bone density. These initial studies show about a 1 to 2% improvement in bone density for the first three years of the study. The most common currently published side effects are abdominal and skeletal pain, nausea, constipation and headache. Markedly severe side effects have not been noticed-a word of caution here-the time duration of this drug is currently relatively short and other drugs have found severe side effects when used with larger population groups for longer periods of time. I have about 75 to 100 females on this drug with relatively low side effects. I really haven't seen the 5% of side effects noted on initial trials. I also caution all my patients that this is a relatively effective: but, untested long term drug. Also, when a female breaks a bone I always suggest several studies to ensure that there is no preventable cause of the fracture. These include Vitamin D levels, Parathyroid levels, and testing for excess proteins with a protein electrophoresis. If these have not been performed you should discuss them with your grandmother's physician.

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