Alendronate sodium

Alendronate sodium is the fourth bisphosphonate to reach the market for the treatment of postmenopausal osteoporosis. Bisphosphonates are potent inhibitors of bone resorption. They reduce pain and complications due to bone metastases, are effective in Paget's disease and in increasing bone mineral density. These agents bind tightly to hydroxyapatite crystals and are retained on bone resorption surfaces. Local release of the bisphosphonates occurs by acidification during the process of the bone resorption to impair the osteoclasts' ability to resorb bone. Alendronate is more potent than other bisphosphonates such as clodronate, pamidronate, and etidronate and is reported to have no deleterious effects on bone. It has also been shown to reduce hypercalcemia in cancer patients.

The second-generation agent alendronate sodium was the first bisphosphonate agent approved by the U.S. FDA for the prevention and treatment of osteoporosis and Paget's disease of the bone and is 1,000-fold more potent than etidronate. This derivative, when dosed continuously (5–10 mg/day for osteoporosis and 40 mg/day for Paget's disease) and given with oral calcium supplements (500 mg/day), produced well-mineralized bone and significantly improved BMD (7% in the spine and 4% in the hip) within 18 months. In addition, the vertebral fracture rate was shown to decrease by 47%. A side effect associated with alendronate, chemical esophagitis, has been attributed to inadequate intake of water and lying down after taking the medication. Specific patient instructions were developed to limit the incidence of upper gastrointestinal problems and include: 1) taking the medication with 6 to 8 ounces of water on arising in the morning, 2)remaining in an upright position for at least 30 minutes after taking the medication, and 3) delaying drinking other liquids/eating for at least 30 minutes, if not 1 to 2 hours, to allow maximal absorption of the agent. To enhance absorption, calcium supplements and any aluminum- or magnesium-containing antacids should be dosed separately from the agents in this class.

The second-generation agent alendronate sodium was the first bisphosphonate agent approved by the U.S. FDA for the prevention and treatment of osteoporosis and Paget's disease of the bone and is 1,000-fold more potent than etidronate.