What Is Fosamax
Fosamax (alendronate) is one of a class of drugs called bisphosphonates. This class also includes Actonel (risedronate), Boniva (ibandronate) and Reclast (zoledronic acid). Bisphosphonates are used to treat osteoporosis, a condition that causes bones to lose density and become brittle and prone to fracture.
Bone Turnover
Bone is a living tissue. Healthy bone undergoes a continuous process where old bone is resorbed by the body and new bone is generated. In osteoporosis, bone is resorbed, but the body fails to generate sufficient amounts of new bone. The bone structure weakens, and fractures may occur after minor falls or bumps. Osteoporotic fractures most often occur in the hip, wrist and spine, causing a humped appearance.
Long-Term Use
Bisphosphonates have been on the market for about a decade, so information on long-term use is beginning to accumulate. Recent letters in the New England Journal of Medicine reported cases of unusual fractures in the long thigh bones of women who had been taking Fosamax for more than seven years. Some of the women reported thigh pain several months before the fracture occurred, suggesting that microscopic fractures had been present but undetected. Researchers believe that bisphosphonates not only suppress bone resorption, but also interfere with new bone formation. This effect is seen only after bisphosphonates have been used for more than five years.
Osteonecrosis of the Jaw
Another unusual but serious side effect associated with bisphosphonates is osteonecrosis of the jaw, where the jawbone decays and causes endodontic problems. This side effect is noted on the warning label for bisphosphonates, but it is important to note it happens very rarely. Although osteonecrosis has been seen in people taking bisphosphonates, most people with this condition are undergoing chemotherapy treatment for cancer and are taking intravenous bisphosphonates to treat cancer that has spread to the bone.
Cautions
Osteonecrosis of the jaw and unusual fractures associated with bisphosphonates are both very rare side effects. These side effects are most commonly associated with Fosamax specifically, but that does not imply that Fosamax is less safe than other bisphosphonates. Fosamax was the first drug in the class to be approved, and it has the most accumulated patient information. For most people, the risks associated with not taking bisphosphonates, that is, hip and other osteoporotic fractures, far outweigh the risk of either of these unusual side effects. Do not stop taking bisphosphonates without consulting your doctor.
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