Alendronic Acid (Alendronate): What You Need to Know
Alendronat Aurobindo Weekly Tablet – Bisphosphonate for Osteoporosis Prevention and Treatment
Alendronic acid (brand names include Alendronat Aurobindo, Binosto, and Fosamax) is a bisphosphonate medication prescribed to treat and prevent osteoporosis in postmenopausal women. Taken as a single 70 mg tablet once per week, it works by slowing bone breakdown and helping to rebuild bone, significantly reducing the risk of vertebral and hip fractures. This guide covers everything you need to know about alendronic acid, including how to take it correctly, potential side effects, drug interactions, and important safety warnings.
Quick Facts: Alendronic Acid
Key Takeaways
- Alendronic acid 70 mg is taken once weekly to treat and prevent osteoporosis in postmenopausal women, reducing fracture risk by up to 50%.
- Always take it first thing in the morning on an empty stomach with a full glass of plain water only (at least 200 ml) – never with mineral water, coffee, juice, or milk.
- You must remain upright (sitting, standing, or walking) for at least 30 minutes after swallowing to prevent esophageal irritation.
- Common side effects include bone, muscle, and joint pain; gastrointestinal symptoms such as heartburn and abdominal discomfort are also reported.
- Have a dental check-up before starting treatment, as rare cases of osteonecrosis of the jaw (ONJ) have been reported with long-term bisphosphonate use.
What Is Alendronic Acid and What Is It Used For?
Quick answer: Alendronic acid is a non-hormonal bisphosphonate that prevents bone loss, helps rebuild bone, and reduces the risk of spine and hip fractures in postmenopausal women with osteoporosis. It is taken as a single 70 mg tablet once per week.
Alendronic acid belongs to a group of medicines called bisphosphonates. Unlike hormone replacement therapy, it is a non-hormonal treatment that works directly on bone tissue. Its primary mechanism involves binding to hydroxyapatite crystals in bone and inhibiting the activity of osteoclasts – the cells responsible for breaking down bone. By reducing the rate of bone resorption (breakdown), alendronic acid allows the bone-building cells (osteoblasts) to work more effectively, gradually increasing bone mineral density over time.
Osteoporosis (ICD-10: M80–M82; SNOMED CT: 64859006) is a systemic skeletal disease characterised by reduced bone mass and deterioration of bone microarchitecture, leading to increased bone fragility and susceptibility to fractures. According to the World Health Organization (WHO), osteoporosis affects an estimated 200 million women worldwide. After menopause, the decline in oestrogen production accelerates bone loss, making postmenopausal women particularly vulnerable. The International Osteoporosis Foundation (IOF) estimates that one in three women over the age of 50 will experience an osteoporotic fracture in their lifetime.
Clinical trials have demonstrated that alendronic acid significantly reduces fracture risk. The landmark Fracture Intervention Trial (FIT), published in the Journal of the American Medical Association, showed that alendronate reduced the risk of vertebral fractures by approximately 47% and hip fractures by approximately 51% over three years in women with existing vertebral fractures. The National Institute for Health and Care Excellence (NICE) in the United Kingdom recommends alendronic acid as the first-line pharmacological treatment for osteoporosis prevention.
Beyond fracture prevention, alendronic acid has been shown to increase bone mineral density at the spine, hip, and other skeletal sites. These improvements continue to accrue over several years of treatment, with some studies demonstrating continued benefits for up to 10 years. Your doctor may monitor your bone density with DEXA scans (dual-energy X-ray absorptiometry) to assess your response to treatment.
While taking alendronic acid, you can further support bone health through lifestyle changes. The WHO and IOF recommend: stopping smoking, engaging in regular weight-bearing exercise (such as walking, jogging, or dancing), maintaining a balanced diet rich in calcium and vitamin D, and limiting alcohol consumption. Your doctor may also recommend supplemental calcium (1,000–1,200 mg daily) and vitamin D (800–1,000 IU daily) to ensure adequate nutrient intake for bone health.
Available Brands of Alendronic Acid 70 mg Weekly
Alendronic acid 70 mg is marketed under several brand names, all containing the same active substance at the same strength. These include:
- Alendronat Aurobindo Weekly Tablet – manufactured by Aurobindo Pharma
- Alendronat Sandoz Weekly Tablet – manufactured by Sandoz
- Alendronat Teva Weekly Tablet – manufactured by Teva Pharmaceuticals
- Alendronat Viatris Weekly Tablet – manufactured by Viatris
- Binosto – an effervescent tablet formulation
- Fosamax – the original branded product by Merck (now available as generic)
All of these products are bioequivalent, meaning they deliver the same amount of active drug to the body. Your pharmacist may dispense any of these brands depending on availability. If you have questions about switching between brands, consult your doctor or pharmacist.
What Should You Know Before Taking Alendronic Acid?
Quick answer: Do not take alendronic acid if you have esophageal problems, cannot stay upright for 30 minutes, have low blood calcium, or are allergic to any ingredient. Tell your doctor about any kidney problems, dental conditions, or other medications you are taking.
Do Not Take Alendronic Acid If:
- You are allergic (hypersensitive) to alendronic acid, sodium alendronate trihydrate, or any of the other ingredients listed in this medicine.
- You have problems with your oesophagus (the tube connecting your mouth to your stomach), such as narrowing (stricture) or difficulty swallowing (dysphagia).
- You are unable to stand or sit upright for at least 30 minutes after taking the tablet.
- You have been told by your doctor that you have low blood calcium levels (hypocalcaemia).
These contraindications exist because alendronic acid can cause serious irritation to the oesophageal lining if it does not pass quickly into the stomach. Patients who cannot maintain an upright position are at significantly increased risk of oesophageal injury. Low calcium levels must be corrected before starting treatment because bisphosphonates can further reduce calcium availability, potentially leading to dangerous complications such as muscle spasms, seizures, or heart rhythm disturbances.
Warnings and Precautions
Before starting alendronic acid, inform your doctor if you have any of the following conditions, as special care or monitoring may be necessary:
- Kidney problems: Alendronic acid is not recommended for patients with severe renal impairment (creatinine clearance below 35 ml/min). Your doctor may need to adjust your treatment or monitor your kidney function more closely.
- Swallowing difficulties or digestive problems: Including Barrett’s oesophagus, gastritis, duodenitis, or a history of ulcers. Alendronic acid can cause oesophageal irritation, inflammation, and ulceration, and these conditions may increase your risk.
- Malabsorption syndrome: Conditions affecting the gut’s ability to absorb nutrients may interfere with the effectiveness of this medicine.
- Low calcium levels: Hypocalcaemia must be corrected before treatment begins. Ensure adequate calcium and vitamin D intake during therapy.
- Dental problems or planned dental procedures: Inform your doctor and dentist if you have gum disease, poorly fitting dentures, planned tooth extractions, or poor oral hygiene. A rare but serious condition called osteonecrosis of the jaw (ONJ) has been reported in patients taking bisphosphonates, particularly those undergoing invasive dental procedures.
The European Medicines Agency (EMA) and the American Association of Oral and Maxillofacial Surgeons recommend a dental examination before starting bisphosphonate therapy. Risk factors for osteonecrosis of the jaw include cancer treatment (chemotherapy, radiotherapy), use of angiogenesis inhibitors (such as bevacizumab or thalidomide), use of corticosteroids (such as prednisolone or dexamethasone), poor oral hygiene, smoking, and invasive dental procedures. Maintain good oral hygiene throughout treatment and inform your dentist that you are taking a bisphosphonate before any dental work.
Additional Precautions
- Cancer or cancer treatment: If you are receiving chemotherapy, radiotherapy, or taking angiogenesis inhibitors, your risk of ONJ may be higher.
- Corticosteroid use: Long-term corticosteroids (prednisolone, dexamethasone) can accelerate bone loss and increase the risk of dental complications.
- Smoking: Increases the risk of dental complications and negatively affects bone health overall.
- Oesophageal irritation: If you develop new or worsening symptoms of heartburn, difficulty swallowing, pain behind the breastbone, or worsening indigestion, stop taking the tablet and contact your doctor promptly.
Children, Pregnancy, and Breastfeeding
Alendronic acid is not recommended for children or adolescents under 18 years of age, as safety and efficacy have not been established in this population. This medicine is indicated only for postmenopausal women. It should not be taken during pregnancy or while breastfeeding. If you think you may be pregnant or are planning a pregnancy, do not take this medicine and consult your doctor immediately.
Driving and Operating Machinery
Some side effects of alendronic acid, including blurred vision, dizziness, and severe bone, muscle, or joint pain, may affect your ability to drive or operate machinery. If you experience any of these symptoms, avoid driving until they resolve. The incidence of these effects is generally low, but you should assess your own response to the medicine before undertaking activities requiring alertness.
Sodium Content
Alendronat Aurobindo Weekly Tablet contains less than 1 mmol sodium (23 mg) per tablet, meaning it is essentially “sodium-free.” This is relevant for patients on a sodium-restricted diet, such as those with heart failure or hypertension.
How Does Alendronic Acid Interact with Other Drugs?
Quick answer: Calcium supplements, antacids, and any food or drink (including mineral water) taken within 30 minutes of alendronic acid will significantly reduce its absorption. NSAIDs may increase the risk of gastrointestinal side effects.
Drug interactions with alendronic acid are primarily related to its absorption in the gastrointestinal tract. Alendronic acid has very low oral bioavailability (approximately 0.6–0.7% on an empty stomach), and this is further reduced to essentially zero when taken with food, beverages, or other medications. Understanding these interactions is critical for ensuring therapeutic efficacy.
| Interacting Substance | Type of Interaction | Clinical Significance | Recommendation |
|---|---|---|---|
| Calcium supplements | Reduced absorption | High – calcium binds alendronic acid in the gut, preventing absorption | Wait at least 30 minutes (preferably 1–2 hours) after alendronic acid before taking calcium |
| Antacids (aluminium, magnesium hydroxide) | Reduced absorption | High – metal ions chelate with alendronic acid | Do not take antacids within 30 minutes of alendronic acid |
| Iron supplements | Reduced absorption | Moderate – iron can impair absorption | Take iron supplements at a different time of day |
| NSAIDs (aspirin, ibuprofen, naproxen) | Additive GI toxicity | Moderate – increased risk of gastric ulcers and GI bleeding | Use with caution; monitor for GI symptoms |
| Corticosteroids (prednisolone, dexamethasone) | Additive bone loss | Moderate – corticosteroids accelerate osteoporosis | May need concurrent bisphosphonate; inform your doctor |
| Food, beverages, mineral water | Reduced absorption | Very high – bioavailability drops to near zero | Take alendronic acid only with plain (tap) water; wait 30 min before eating/drinking |
The British National Formulary (BNF) and EMA SmPC both emphasise that alendronic acid must be taken strictly on an empty stomach with plain water to ensure adequate absorption. Even mineral water, which contains calcium and other divalent cations, can reduce absorption. Coffee, tea, juice, and milk are particularly problematic because they contain substances that rapidly form insoluble complexes with alendronate in the stomach.
If you take multiple medications, discuss the optimal timing with your pharmacist. A practical approach is to take alendronic acid immediately upon waking, wait at least 30 minutes (or ideally 60 minutes), and then take your other morning medications along with breakfast. Calcium and vitamin D supplements are best taken later in the day, such as with lunch or dinner.
There is no significant interaction between alendronic acid and common medications for hypertension, diabetes, thyroid disease, or depression. However, always inform your doctor and pharmacist about all medicines you are taking, including over-the-counter products, herbal remedies, and dietary supplements.
What Is the Correct Dosage of Alendronic Acid?
Quick answer: The standard dose is one 70 mg tablet taken once weekly, on the same day each week, first thing in the morning before food, drink, or other medicines. Swallow whole with at least 200 ml of plain water and stay upright for 30 minutes.
Standard Dosage
Adults (postmenopausal women): One 70 mg tablet once weekly
Children and adolescents (<18 years): Not recommended
How to Take Alendronic Acid Correctly
The way you take alendronic acid is critically important for both its effectiveness and your safety. Incorrect administration can lead to severe oesophageal injury and dramatically reduced drug absorption. Follow these instructions carefully:
- Choose a fixed day of the week that is convenient for you and take the tablet on that same day every week. Many patients choose a Monday or another memorable day.
- Take the tablet first thing in the morning, before eating or drinking anything and before taking any other medicines.
- Swallow the tablet whole with a full glass of plain water (at least 200 ml / 7 fl oz). Do NOT use mineral water, sparkling water, coffee, tea, juice, or milk. These beverages can reduce absorption by more than 60%.
- Do NOT chew, crush, or dissolve the tablet. The tablet must reach the stomach intact to minimise oesophageal contact.
- Remain upright (sitting, standing, or walking) for at least 30 minutes after swallowing. Do NOT lie down or recline during this time.
- Do NOT take the tablet at bedtime or before getting up for the day. You must be fully upright when and after you take it.
- Wait at least 30 minutes before eating your first food of the day, drinking anything other than plain water, or taking any other oral medications.
Alendronic acid has one of the lowest oral bioavailabilities of any commonly prescribed drug – approximately 0.6% under ideal fasting conditions. Even small amounts of food, calcium, or minerals in water can bind to the drug molecule and prevent it from being absorbed. Research published in the Journal of Clinical Pharmacology confirmed that taking alendronate with coffee reduced bioavailability by approximately 60%, while orange juice reduced it by approximately 60% as well. Only plain (tap or filtered) water preserves the drug’s already-limited absorption.
What to Do If You Miss a Dose
If you forget to take your weekly tablet on your chosen day, take it the next morning after you remember. Follow all the usual instructions (empty stomach, plain water, stay upright). Then go back to taking your tablet on your regular chosen day. Do NOT take two tablets on the same day. Do NOT take a double dose to make up for a missed one.
What to Do in Case of Overdose
If you or someone else accidentally takes too many tablets, drink a full glass of milk and contact your doctor or local poison control centre immediately. Do NOT try to induce vomiting. Do NOT lie down, as this increases the risk of oesophageal irritation. Overdose may cause low blood calcium (hypocalcaemia), low blood phosphate (hypophosphataemia), and upper gastrointestinal adverse events such as stomach upset, heartburn, oesophagitis, gastritis, or ulceration.
Duration of Treatment
Alendronic acid is intended for long-term use. The NICE guidelines (TA464) and National Osteoporosis Foundation (NOF) recommend reassessing the need for continued treatment after 3 to 5 years. For patients at high fracture risk, treatment may continue for up to 10 years. Your doctor will periodically evaluate your bone density, fracture risk factors, and overall health to determine the optimal treatment duration for you. Do not stop taking the medicine without consulting your doctor first.
What Are the Side Effects of Alendronic Acid?
Quick answer: The most common side effects are bone, muscle, and joint pain (affecting more than 1 in 10 people). Gastrointestinal effects such as heartburn, abdominal pain, and oesophageal irritation are also common. Rare but serious effects include osteonecrosis of the jaw and atypical femoral fractures.
Like all medicines, alendronic acid can cause side effects, although not everybody gets them. Most side effects are mild to moderate and tend to resolve with continued use or after dose adjustment. However, some side effects are serious and require immediate medical attention. The following information is based on post-marketing surveillance data, clinical trial results, and the EMA Summary of Product Characteristics (SmPC).
Very Common (affects more than 1 in 10 people)
Frequency: >10%
- Bone pain (sometimes severe at treatment initiation)
- Muscle pain (myalgia)
- Joint pain (arthralgia)
Common (affects 1 to 10 in every 100 people)
Frequency: 1–10%
- Heartburn (acid reflux, dyspepsia)
- Pain or difficulty swallowing (dysphagia, odynophagia)
- Oesophageal ulcers
- Joint swelling
- Abdominal pain, bloating, gas (flatulence)
- Constipation or diarrhoea
- Belching (eructation)
- Hair loss (alopecia)
- Itching (pruritus)
- Headache and dizziness
- Tiredness (fatigue) and general malaise
- Swelling of hands or feet (peripheral oedema)
Uncommon (affects 1 to 10 in every 1,000 people)
Frequency: 0.1–1%
- Nausea and vomiting
- Oesophageal irritation or inflammation (oesophagitis)
- Black or tarry stools (melaena – may indicate GI bleeding)
- Blurred vision, eye pain, or redness
- Skin rash, redness (erythema)
- Flu-like symptoms (fever, chills, body aches)
- Taste disturbances (dysgeusia)
Rare (affects 1 to 10 in every 10,000 people)
Frequency: 0.01–0.1%
- Allergic reactions: hives (urticaria), swelling of the face, lips, tongue, or throat (angioedema)
- Severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis)
- Osteonecrosis of the jaw (ONJ): jaw pain, swelling, sores, numbness, loose teeth, or exposed jawbone
- Atypical femoral fractures: unusual fractures of the thigh bone, sometimes preceded by dull aching thigh or groin pain
- Severe bone, muscle, or joint pain (may be incapacitating)
- Symptoms of low blood calcium (hypocalcaemia): muscle cramps, tingling, numbness
- Gastric or peptic ulcers
- Oesophageal stricture (narrowing)
- Photosensitive skin rash (rash triggered by sun exposure)
- Mouth ulcers (if tablet is chewed or dissolved in mouth)
Very Rare (affects fewer than 1 in 10,000 people)
Frequency: <0.01%
- Ear pain, ear discharge, or ear infection (osteonecrosis of the external auditory canal – bone damage in the ear canal)
- Severe difficulty swallowing or chest pain – may indicate oesophageal ulceration or perforation
- Black or tarry stools – may indicate gastrointestinal bleeding
- Swelling of face, lips, tongue, or throat – signs of a serious allergic reaction
- Jaw pain, swelling, or numbness – possible osteonecrosis of the jaw
- New or unusual thigh or groin pain – possible atypical femoral fracture
- Severe skin rash with blistering – may indicate Stevens-Johnson syndrome
Osteonecrosis of the Jaw (ONJ)
Osteonecrosis of the jaw is a rare but potentially serious complication of bisphosphonate therapy. It involves the death of bone tissue in the jaw, typically presenting as exposed bone, pain, swelling, numbness, or infection in the jaw area. The FDA and EMA have both issued guidance on this risk. While the absolute risk in patients taking oral bisphosphonates for osteoporosis is estimated at between 1 in 10,000 and 1 in 100,000 patient-years, the risk increases significantly with intravenous bisphosphonates used in cancer treatment. Risk factors include dental surgery, poor oral hygiene, ill-fitting dentures, gum disease, concurrent corticosteroid or chemotherapy use, and smoking.
Atypical Femoral Fractures
Long-term use of bisphosphonates (typically more than 3–5 years) has been associated with rare, atypical fractures of the femur (thigh bone). These fractures may occur with minimal or no trauma, often in the subtrochanteric or diaphyseal region of the femur. Warning signs include new or unusual dull aching pain in the thigh, hip, or groin. If you experience such symptoms, contact your doctor. The American Society for Bone and Mineral Research (ASBMR) has published criteria for identifying these fractures, and your doctor may recommend a drug holiday (temporary discontinuation) after 3–5 years of treatment to mitigate this risk.
If you experience any side effects not listed above, or if any listed side effects become severe, contact your doctor or pharmacist. You can also report side effects directly to your national medicines agency (such as the MHRA Yellow Card Scheme in the UK, the FDA MedWatch programme in the US, or the EMA EudraVigilance system in the EU).
How Should You Store Alendronic Acid?
Quick answer: Store at room temperature with no special storage requirements. Keep out of reach of children. Do not use after the expiry date printed on the packaging.
Proper storage of alendronic acid ensures the medicine remains effective and safe throughout its shelf life. Follow these storage guidelines:
- Keep out of sight and reach of children. Store the medicine in a location that children cannot access.
- No special storage conditions are required. The tablets can be stored at normal room temperature (below 25°C / 77°F is generally recommended).
- Do not use after the expiry date printed on the blister pack, bottle, or outer carton. The expiry date refers to the last day of that month.
- Keep the tablets in the original packaging to protect from moisture.
- Do not dispose of medicines via wastewater or household waste. Ask your pharmacist how to dispose of medicines you no longer use. This helps protect the environment.
If you notice any change in the appearance of the tablets (such as discolouration, crumbling, or an unusual odour), do not take them and consult your pharmacist. These changes may indicate that the medicine has degraded.
What Does Alendronic Acid Contain?
Quick answer: Each tablet contains 70 mg of alendronic acid (equivalent to 91.363 mg of sodium alendronate trihydrate) along with inactive excipients including microcrystalline cellulose, maize starch, and magnesium stearate.
Active Ingredient
The active substance is alendronic acid 70 mg, present as sodium alendronate trihydrate 91.363 mg. Alendronic acid is the pharmacologically active moiety, while the sodium salt form (trihydrate) improves the tablet’s stability and manufacturing properties.
Excipients (Inactive Ingredients)
| Excipient | Function |
|---|---|
| Microcrystalline cellulose | Diluent / binder |
| Maize starch | Disintegrant / filler |
| Sodium starch glycolate (type A) | Disintegrant (superdisintegrant) |
| Povidone (K 30) | Binder |
| Magnesium stearate | Lubricant |
Tablet Appearance and Pack Sizes
Alendronat Aurobindo 70 mg tablets are white to off-white, oval, biconvex, uncoated tablets with “F” debossed on one side and “21” on the other side. The tablets measure approximately 12.8 mm × 7.0 mm.
The tablets are available in the following pack sizes:
- Blister packs: 2, 4, 8, 12, or 60 tablets
- HDPE bottles: 30, 90, 100, or 250 tablets
Not all pack sizes may be marketed in every country. Your pharmacist will dispense the appropriate pack size based on your prescription.
Marketing Authorisation Holder and Manufacturer
The marketing authorisation holder is Aurobindo Pharma (Malta) Limited. The manufacturing site may vary depending on the market. For the most current information about the manufacturer, refer to the patient information leaflet included in the product packaging or consult your pharmacist.
Frequently Asked Questions About Alendronic Acid
Alendronic acid is a bisphosphonate medication used to treat and prevent osteoporosis in postmenopausal women. It works by slowing down bone loss, helping to rebuild bone tissue, and reducing the risk of vertebral (spine) and hip fractures. It is the most widely prescribed medication for osteoporosis worldwide, recommended as first-line treatment by NICE, the NOF, and other international guidelines.
Take one 70 mg tablet once weekly, first thing in the morning, on an empty stomach. Swallow it whole (do not chew or crush) with a full glass of plain water – at least 200 ml. Do not use mineral water, juice, coffee, tea, or milk. After swallowing, stay upright (sitting, standing, or walking) for at least 30 minutes. Do not eat, drink anything else, or take any other medicines during that 30-minute window. Choose a consistent day each week for your dose.
While most side effects are mild, rare but serious side effects include: osteonecrosis of the jaw (ONJ), which involves death of jawbone tissue; atypical femoral fractures (unusual breaks in the thigh bone); severe oesophageal reactions including ulceration and stricture; and serious allergic reactions. If you experience jaw pain or numbness, unusual thigh pain, severe difficulty swallowing, or signs of an allergic reaction (swelling of face/lips/throat), seek immediate medical attention.
Yes, but timing is crucial. Calcium supplements, antacids, iron supplements, and any food or drink will dramatically reduce the absorption of alendronic acid if taken too close together. Always take alendronic acid at least 30 minutes (ideally 60 minutes) before any other oral medication, food, or drink. NSAIDs (such as aspirin and ibuprofen) can be used but may increase the risk of gastrointestinal side effects. Always tell your doctor about all medications you are taking.
Current guidelines from NICE and the NOF recommend reassessing treatment after 3 to 5 years. For patients at high fracture risk, treatment may be continued for up to 10 years. After prolonged use, your doctor may suggest a “drug holiday” (temporary break from treatment) to reduce the risk of rare long-term side effects such as atypical femoral fractures and osteonecrosis of the jaw. Never stop the medication without consulting your doctor first.
If you miss your weekly dose, take one tablet the next morning after you remember. Follow all the usual instructions (empty stomach, plain water, stay upright for 30 minutes). Then return to your regular schedule on your usual chosen day. Do not take two tablets on the same day or a double dose. If you frequently forget doses, consider setting a weekly phone alarm or using a pill reminder app.
In rare cases (estimated 1 in 10,000 to 1 in 100,000 patient-years for oral bisphosphonates), alendronic acid can be associated with osteonecrosis of the jaw (ONJ). Risk factors include dental surgery, poor oral hygiene, cancer treatment, corticosteroid use, and smoking. The EMA and dental specialist organisations recommend a dental check-up before starting treatment. Maintain excellent oral hygiene throughout treatment and always inform your dentist that you take a bisphosphonate before any dental procedures.
References
- Black DM, Cummings SR, Karpf DB, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. The Lancet. 1996;348(9041):1535-1541. doi:10.1016/S0140-6736(96)07088-2
- Cummings SR, Black DM, Thompson DE, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures (FIT Clinical Trial). JAMA. 1998;280(24):2077-2082. doi:10.1001/jama.280.24.2077
- National Institute for Health and Care Excellence (NICE). Bisphosphonates for treating osteoporosis. Technology appraisal guidance [TA464]. 2017. www.nice.org.uk/guidance/ta464
- European Medicines Agency (EMA). Summary of Product Characteristics: Alendronic Acid. www.ema.europa.eu
- World Health Organization (WHO). Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO Technical Report Series 843. Geneva: WHO, 1994.
- Shane E, Burr D, Abrahamsen B, et al. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2014;29(1):1-23. doi:10.1002/jbmr.1998
- Ruggiero SL, Dodson TB, Fantasia J, et al. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw – 2014 update. J Oral Maxillofac Surg. 2014;72(10):1938-1956. doi:10.1016/j.joms.2014.04.031
- Kanis JA, Cooper C, Rizzoli R, Reginster JY. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2019;30(1):3-44. doi:10.1007/s00198-018-4704-5
- British National Formulary (BNF). Alendronic acid. bnf.nice.org.uk
- International Osteoporosis Foundation (IOF). Epidemiology of osteoporosis and fragility fractures. www.osteoporosis.foundation
Editorial Team
This article was written and reviewed by the iMedic Medical Editorial Team, comprising board-certified specialists in clinical pharmacology, rheumatology, and endocrinology. Our editorial process follows the GRADE evidence framework and adheres to international guidelines from the WHO, EMA, FDA, NICE, and BNF.
Content developed by licensed physicians with expertise in osteoporosis management and pharmacotherapy. All clinical claims are supported by Level 1A evidence (systematic reviews and meta-analyses of randomised controlled trials).
Independently reviewed by the iMedic Medical Review Board. The review board verifies medical accuracy, checks all references, ensures guideline adherence, and confirms the content is accessible to a general patient audience.
Conflict of interest: None declared. iMedic receives no pharmaceutical company funding, sponsorship, or advertising revenue. All content is editorially independent.
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