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Alendronate / Fosamax

- Discussion: (see bisphosphonates)
    - type of aminobisphosphonate (a synthetic analogs of pyrophosphate) which acts as an inhibitor of osteoclast-mediated bone resorption;
    - due to substantial reduction in bone resorption, bone formation exceeds bone resorption at these remodeling sites, which leads to
               progressive gains in bone mass;
    - this medication should be taken at least 30 min before meals and/or liquids, and patients should not lie down for at least 30 min
              after taking this medication;

- Use in Osteoporosis: (see osteoporosis)
    - indicated for both the prevention and treatment of osteoporosis;
    - in postmenopausal women with low bone mass at the femoral neck or with previous vertebral fractures, fosamax has been demonstrated  
            to significantly reduce the incidence of fractures at the spine, hip, and wrist in postmenopausal females;
            - in women w/o these risk factors, there is no signficant fracture risk reduction;
    - typical dosage is 5 - 10 mg PO qd;
    - now available in a weekly dose of 70 mg (PO q week);
    - note that as soon as the medication is discontinued, bone resorption will return to its previous rate, and by one year, the magnitude of the
            pretreatment osteoporosis may be be present;

- Use in Pagets Disease: (see Paget's disease);
    - at higher doses, fosamax will inhibit both bone resorption and formation;
    - bone that is formed has normal histologic features;
    - usual dose is 40 mg PO qd for 6 months;

- Cautions:
    - may cause esophageal and/or GI irritation;
    - may cause hypocalcemia, especially with concomitant IV aminoglycosides;
    - may cauese renal impairment 

Effect of alendronate on bone ingrowth into porous tantalum and carbon fiber interbody devices: an experimental study on spinal fusion in pigs.