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Bisphosphonate Pregnancy: D — contraindicated

Alendronic Acid

Brand names: Fosamax, Binosto (effervescent)

Adult dose

Dose: 70mg once weekly or 10mg once daily
Route: Oral
Frequency: Once weekly (preferred) or once daily
Take on empty stomach in morning with full glass water. Remain upright for 30 min. Do not take with food, other medication, or mineral water.

Clinical pearls

  • STRICT: take first thing in morning, fasting, with 200mL water, remain upright for 30 min
  • Weekly dose (70mg) has same efficacy as daily (10mg) with better adherence and tolerability
  • Pre-treat with calcium and vitamin D (correct deficiency before starting)
  • Dental assessment before starting — ONJ risk
  • First-line for osteoporosis management in UK (NICE approved)

Contraindications

  • Oesophageal abnormalities (achalasia, stricture)
  • Inability to sit/stand upright for 30 min
  • Hypocalcaemia
  • eGFR <35 mL/min

Side effects

  • Oesophageal ulceration/stricture
  • Abdominal pain
  • Osteonecrosis of the jaw
  • Atypical femoral fracture (long-term)
  • Uveitis

Interactions

  • Calcium/antacids/iron — prevent absorption (take 30 min apart from all other medications)
  • NSAIDs — additive GI toxicity

Monitoring

  • DEXA scan every 1–2 years
  • Renal function before starting and annually
  • Calcium levels (correct deficiency before starting)
  • Dental health annually

Reference: NOGG Osteoporosis Guidelines 2021; NICE TA160. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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