The People's Perspective on Medicine



Fosamax is prescribed to prevent or treat osteoporosis in postmenopausal women. Doctors prescribe it to increase bone mass in men with osteoporosis. It is also used to treat a fairly rare condition, Paget's disease of bone.

Bone is constantly being "remodeled," broken down by osteoclasts and rebuilt by osteoblasts. Under normal conditions, these two types of bone cells should work together.

With aging, the osteoblasts often slow down, and more bone is destroyed ("resorbed") than is constructed. Fosamax slows the osteoclasts so that bone-building osteoblasts can keep up or get ahead.

Side Effects and Interactions

Fosamax may occasionally cause stomach ache, nausea, constipation or diarrhea, flatulence, trouble swallowing, and esophageal ulcer.

Although esophageal ulcers are uncommon, they can be extremely serious. Another rare but dangerous reaction that has been reported is osteonecrosis of the jaw–death of the jaw bone tissue. This has generally been linked to tooth extractions or other invasive dental procedures.

Anyone taking Fosamax who notices difficulty or pain when swallowing, pain behind the breastbone, or new or more intense heartburn should stop Fosamax and contact the physician promptly.

Other side effects such as muscle pain, skin reactions and eye inflammation have also been reported.

Fosamax works best when the patient is getting adequate calcium and vitamin D. These should be taken at least one half-hour after taking Fosamax, to avoid interfering with absorption of the drug.

Aspirin and arthritis pain relievers, both prescription and over-the-counter, can irritate the digestive tract. This may increase the risk of severe esophageal irritation from Fosamax. Antacids should be taken at least 2 hours after Fosamax. They could interfere with absorption if given at the same time.

Check with your doctor and pharmacist to make sure this medicine is safe in combination with any other drugs you take.

Special Precautions

Fosamax can be very irritating to the esophagus. People with any swallowing problems or those who cannot sit or stand for at least 30 minutes should not take Fosamax.

People with ulcers or esophageal disease should avoid Fosamax also.

Fosamax is not recommended for patients with severe kidney disease.

Taking the Medicine

Fosamax is not well absorbed, and must be taken exactly according to instructions.

The pill is to be taken first thing in the morning, right after rising, with a full glass of plain tap water.

Mineral water, coffee, and orange juice may all interfere with drug absorption.

The patient must stay upright, sitting up or standing (not lying down), for at least 30 minutes after taking Fosamax. Only after that half hour has elapsed should she have breakfast, drink coffee or juice, or take other medications.

Best absorption of Fosamax occurs if two hours goes by between taking the pill and eating.

Fosamax may be taken every day or once a week. The same instructions apply to the weekly dose.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I took Fosamax for about 4 months before discontinuing it. I was a pretty active 69 year-old but almost overnight was moving as if I were in my 80s. It worsened my GERD so severely that a few episodes left me crying in pain. Two years later I still feel pain in my esophagus. This terrible drug may have also contributed to a very painful bout of plantar fasciitis as well as worsening peripheral neuropathy–not sure about those. The manufacturer should be sued. No accident that if you put the name into a search engine, a number of the top hits are lawyers looking to represent this drug’s victims. I blame my doctor, too, for not investigating and seemingly not caring. The benefits of this drug are so slender and iffy, and the risks are so great, that I wonder why any dr would advise a patient to take it. This drug damaged me, maybe permanently, and I am angry.

I sure would like some answers to these questions. I TAKE the generic form and the very next day I was in pain. Then my dr. put me on gabapentin three times a day. I do have nerve pain from peripheral neuropathy also. After I started the Fosamax the first time I started getting a very dry mouth, lips and tongue. It is very irritating at night. I quit the Fosamax 4 months ago. Anyway, my doctor convinced me to go back on the Fosamax. So I’m giving it one more try, not sure what the outcome could be. With the things I read I’m not sure I should be taking it at all.

I am taking Metagenics CalApetite with boron plus vitamin D3 and vitamin K2 MK4 100 per day and my bones are getting better in regards to my bone density test results. I also take 500 msgs of magnesium citrate.

No Fosamax for this old gal!!

To Agnes in Texas, I want to try what you are taking as I would like to discontinue Fosamax. Vitamin K2 MK4 100 per day. Can you tell me what this is? Thanks

Some years back I was asked by my Dr. to consider taking Fosamax and/or Evista. After researching both drugs the decision was to take Evista. Now due to the possibility of blood/clots and/or strokes I am no longer taking Evista. Rather than take Alendronate for osteopenia I elected to take the Calcitonin/Salmon nasal spray instead.

Every drug has its side effects so I wonder if I’ve done the right thing though alendronate scares me good deal. Anyone else with experience with the spray?

Two months ago I started taking a weekly dose of ALENDRONATE SODIUM. Very quickly I experienced severe pain and swelling in both feet. X-rays showed no broken bones or arthritis and joints were fine. I could not connect anything I had done with such pain.
Then I listened to your radio show last week about side effects of drugs. As a last resort, I read the fine print insert for Alendronate: “In post marketing experience, severe and occasionally incapacitating bone, joint and/or muscle pain” in hands/ankles/feet. “The time to onset of symptoms varied from one day to several months after starting the drug.” I stopped taking this drug and slowly but surely the pain is decreasing. Thank you!

I am taking 60 mg a day of prednisone and 70mg once a week of alendronate plus 40 mg ceterizine daily.
Are these Meds compatible?

I was on Fosamax for 4 years for osteopenia. In 2004 I developed severe chest pain and had a cardiac workup including a cardiac catheterization that was negative. I was diagnosed with GERD and placed on Nexium. I stopped the Fosamax. I took the Nexium for a couple of years and gradually discontinued it. I was symptom free for years.
In July, 2011 I was diagnosed with osteoporosis and my doctor prescribed Alendronate. I informed her of my previous experience with Fosamax but me convinced me to try the Alendronate. I followed the directions and took it when I awoke, 1 hour before eating and stayed sitting or standing for an hour. In March, 2012 I was admitted to the hospital for severe chest pain and again had a negative cardiac work up including cardiac cath.
I stopped the Alendronate and had an upper endoscopy that showed “irritation” of the esophagus. My gastroenterologist explained the severe chest pain was likely esophageal spasms. I did have difficulty swallowing and food would not go up or down for minutes at a time. I was placed on proloxin and Ranitidine and eventually was able to wean off those meds and remain asymptomatic. Now my doc wants me to take Reclast IV. I was pre approved to take it but decided not to for now.

I started taking Alendronate (Fosamax)7 months a go. My lips started hurting then became blistered. I went to the doctor and he said possibly from the Alendronate so I stopped it 2 months a go. Then I developed a rash under both arms. Went back to doctor and he gave me medication to put on it. Then in my right eye I had blurred vision for two weeks. Then I had a portion of my right eye sight that was gone.
I went back to the doctor and he had me go to an eye doctor. I have had several tests and have had an eye stroke now with vision in my right eye not improved. I feel this is all from the Alendronate as I had no eye problems or skin problems before I started Alendronate.

I have not connected my problem with Fosamax or the generic until I read the above accounts. I have come near to death – choking- on three occasions now. I find swallowing extremely difficult, to the point of not being able to swallow but choking. Can Fosamax cause something as severe as this condition?

I was taking the generic Fosamax for over a year. One morning I had a problem swallowing within a week, could not swallow normally. Made appointment with my Doctor, was admitted to the hospital. The test photos etc came back showing my esophagus bleeding into my stomach. I was given medication and 3 days later, my heart stopped and it was suggested that I receive a Pace Maker.
I stopped taking the generic. many months later, I was getting dressed, bent over slightly and found myself slowly collapsing to the floor. 911 was called, surgery was performed. The surgeon stated that the femur bone had shattered and had to be replaced with a metal rod.
I received Physical therapy, when I was able to come home. I continued physical therapy at home. It has been almost a year now, this February. I still have slight discomfort in the right leg due to the rod. I exercise every day. As of this date I still use a walker. I used a cane before the fall, and hoped to use the cane again. But do not feel comfortable, and have fear of falling again.
Joyce B.

I have been taking Fosamax since 1998. Is it safe and necessary to continue? Thank you please reply.

I have been take fosamax for many years over 15. I want to know if this can do damage to me other than the jaw business. I’m allergic to calcium that is why I have been taking it.

I took fosimax, and could not get up in the morning, had to look for my cane as I could not walk.
I told my doctor I will not take it. I was told that I slept a wrong way at bed at night.

I have been taking fosamax for almost 11 years. Is it safe for me to take this medication for so long? Recently i read an article in my newspaper that said that it wasn’t safe for anyone to take it more than 10 years. Is this safe for me to continue it?

I just found out from the dentist that having a tooth extracted while on Fosamax can cause major issues. I just went to the Fosamax website and they mentioned “delays in jaw healing”. That seems to REALLY minimize what the dentist has told me. Why isn’t the FDA making them beef up their warnings (or at least inform patients to make sure their dentist knows they’re taking it)? I realize the condition may be rare but it sounds really serious for the folks who experience it.

I have taken Fosamax for years for severe Osteoporosis. Now my insurance company wants to force me to switch to the generic form, Alendronate. But I am quite concerned about the effectiveness of this generic because of the increased publicity about generics not being as good as Brand Name drugs. With my condition, it is an important issue! Do you have any reports yet on this generic and/or comparisons to Fosamax?
Thank you so much!

I took fosamax one monday morning and when I woke up on tuesday, I felt like I had aged 20 years overnight. I hurt all over, my bones, my muscles and I was so week for 4 or 5 days I could hardly take care of myself.

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