Alendronic acid

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Alendronic acid or Alendronate (Fosamax, Binosto, among others) belongs to a group of non-hormonal medicines called bisphosphonates.

Alendronic acid prevents the loss of bone that occurs in women after they have been through the menopause, and helps to rebuild bone. It reduces the risk of spine and hip fractures.

At the menopause, the ovaries stop producing the female hormone, estrogen, which helps to keep a woman’s skeleton healthy. As a result, bone loss occurs and bones become weaker. The earlier a woman reaches the menopause, the greater the risk of osteoporosis.

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[edit] BRAND NAMES

[edit] STRUCTURE

Fosamax.jpg

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[edit] MECHANISM OF ACTION

Osteoporosis happens when not enough new bone grows to replace the bone that is naturally broken down. Gradually, the bones become thin and fragile, and more likely to break. Osteoporosis is more common in women after the menopause, when the levels of the female hormone estrogen fall, since estrogen helps to keep bones healthy.

Osteoblasts make bone, while osteoclasts resorb or take away bone. Alendronate is a bisphosphonate, it has no direct effect on bone formation, but it stops the action of the osteoclasts, the cells that are involved in breaking down the bone tissue.
Alendronate is internalized by osteoclasts, causing disruption of osteoclast cytoskeleton, loss of the ruffled border, and the subsequent loss of ability to resorb bone.

[edit] INDICATIONS

  • Treatment and prevention of postmenopausal osteoporosis
  • Treatment to increase bone mass in men with osteoporosis
  • Treatment and prevention of glucocorticoid-induced osteoporosis
  • Treatment of Paget’s disease
  • To reduce hypercalcemia in tumor-induced bone disease

[edit] DOSAGE

  • Postmenopausal Osteoporosis: 10 mg daily or 70 mg once a week
  • Prevention of Postmenopausal Osteoporosis: 5 mg daily or 35 mg once a week
  • Men with Osteoporosis: 10 mg daily or 70 mg once a week
  • Glucocorticoid-Induced Osteoporosis: 5 mg daily or 10 mg daily in postmenopausal women not receiving estrogen
  • Paget’s Disease: 40 mg daily for six months

Swallow tablet with a glass of water, at least 30 minutes before the first food, beverage, or medication of the day. Avoid lying down for 30 minutes. Take supplemental calcium and vitamin D if dietary intake is inadequate.

[edit] CONTRAINDICATIONS

  • Hypersensitivity to Alendronic acid
  • Hypocalcemia
  • Inability to stand or sit upright for at least 30 minutes
  • Abnormalities of the esophagus which delay emptying such as stricture or achalasia

[edit] PRECAUTIONS

  • Bisphosphonates have been associated with esophagitis, gastritis, oesophageal ulcerations and gastroduodenal ulcers. (follow the dosing instructions carefully).
  • Hypocalcemia can worsen and must be corrected prior to use
  • Bisphosphonates may cause osteonecrosis of of the jaw. Potential predisposing factors are tooth extractions, poor oral hygiene, corticosteroids use, alcohol abuse, chemotherapy and radiotherapy.
  • Atypical Femur Fractures have been reported. Patients should be advised to report any thigh or groin pain to rule out an incomplete femur fracture.
  • Severe bone, joint, muscle pain may occur. Discontinue use if severe symptoms develop

[edit] INTERACTIONS

  • Products containing calcium, including milk, and oral medications containing multivalent cations (such as aluminium, magnesium, iron), are likely to interfere with absorption of Alendronate. Patients should wait at least one-half hour after taking Alendronate before taking any other oral medications.
  • Acetylsalicylic acid and other non-steroidal anti-inflammatory medicines (NSAIDs) (including ibuprofen, diclofenac and naproxen) may irritate the stomach and intestine. Bisphosphonates may also do so. caution should be exercised in the concomitant use of Biphosphonates and NSAIDs

[edit] PREGNANCY AND LACTATION

  • Pregnancy Category C (US). Alendronate should be used during pregnancy only if the potential benefit justifies the potential risk to the mother and fetus.
  • It is not known whether alendronate is excreted in human milk, caution should be exercised if administered to nursing women.

[edit] SIDE EFFECTS

Most common adverse reactions are abdominal pain, acid regurgitation, constipation, diarrhea, dyspepsia, musculoskeletal pain, nausea and headache. (See precautions for other possible side effects)

[edit] RELATED LINKS

Fosamax شرح الطريقة السليمة لاستخدام , How to use Fosamax (arabic)
How osteoporosis develops
Calcium and phosphate homeostasis, including discussion of vitamin D metabolism and the actions of PTH

[edit] BIBLIOGRAPHY

[edit] REFERENCES