Question

Mrs. S. is a 73-year-old healthy female who is being seen in the clinic. She has just been diagnosed with post-menopausal osteoporosis. She is being prescribed Alendronate (Fosamax) 70 mg weekly.


1. You need to provide patient education to her. The only other medication she takes is Ibuprophen as needed for headaches.

She asks you what osteoporosis is, what caused it and how it is treated.

2. Explain your teaching plan for Mrs. S.

Be sure to address her questions about osteoporosis in addition to education about Fosamax.

Answer 1

Osteoporosis is the thinning of bones caused because of the pores in the bones getting bigger. The bones will lose strength and density due to this thinning. Being a 73-year-old postmenopausal Mrs. S is at increased risk for osteoporosis. Postmenopausal women in this age are more susceptible to osteoporosis since this is linked to estrogen deficiency. During this period, the drop in estrogen level leads to more bone absorption (resorption) than formation, resulting in osteoporosis. Osteoporosis can be controlled by using alendronate (Fosamax) 70 mg weekly, regular exercise, eating foods rich in calcium, taking supplements like calcium with vitamin D, estrogen treatment if needed.

There are several facts that an osteoporosis patient should know while taking Fosamax. These are:

a. Instructions/warnings:

Fosamax (alendronate) 70 mg should be taken weekly once with a bone density test as ordered.

The patient should not lie down after taking the medicine. Fosamax can damage the esophagus and the water will wash down the medication to the stomach. There are chances that the medication might come back to the food pipe while lying down. Ibuprofen should not be taken with Fosamax. Any other supplements should be taken only half-an-hour after taking Fosamax.

b. Action of Fosamax:

Alendronate belongs to bisphosphonates class of medications. It works by preventing bone breakdown and bone resorption, and increasing bone density. It inhibits the resorption of bone by the osteoclasts, the bone-breaking cells, and has an effect on osteoblasts, the bone-building cells. This drug is structurally similar to pyrophosphate in the human body and this structure enables the drug to remain in bone for many years.

c. Overdose symptoms:

Hypophosphatemia and hypocalcemia may be caused by an overdose of Fosamax. Gastrointestinal reactions such as heartburn, stomach upset, gastritis, esophagitis, ulcer, etc are also caused because of oral overdose.

d. Side effects:

Fosamax gives bone, muscle, and joint pain with long-term usage.

Three years of Fosamax usage results in a 4% to 8% increase in bone density. Researchers suggest stopping this medicine after 5 years for the next 5 years due to the side effects associated with its long-term use. However, it should be stopped only after consulting the physician and as directed by the physician.