Alendronic acid or Alendronate, sold under the brand name Fosamax among others, is a bisphosphonate medication used to treat osteoporosis and Paget's disease of bone, which works by decreasing the activity of osteoclasts, the cells that break down bone. It is taken by mouth as the neutral sodium salt, alendronate sodium, but is absorbed as the active free drug alendronic acid. Use is often recommended together with vitamin D, calcium supplementation, and lifestyle changes.
Common side effects (1 to 10% of patients) include constipation, abdominal pain, nausea, and acid reflux; though the rate of all side effects were found by the Fracture Intervention Trial, which followed 2,027 women with osteoporosis for three years, to be nearly identical to that of the placebo. The study further found that the risk of a serious upper gastrointestinal adverse event was 60% lower (p<0.01) for the drug versus the placebo. Use is not recommended during pregnancy or in those with poor kidney function.
Alendronic acid was first described in 1978 and approved for medical use in the United States in 1995 as alendronate sodium (Fosamax). It is available as a <span lang="en" dir="ltr">generic medication</span>. In 2023, it was the 113th most commonly prescribed medication in the United States, with more than 5million prescriptions.
Alendronatec sodium is indicated for the treatment and prevention of osteoporosis in postmenopausal women; the treatment to increase bone mass in men with osteoporosis; the treatment of glucocorticoid-induced osteoporosis; and the treatment of Paget's disease of bone.
Nitrogen containing bisphosphonates, which include ibandronate, pamidronate and alendronate exert their effects on osteoclasts mainly by inhibiting the synthesis of isoprenoid lipids such as isopentenyl diphosphate (IPP), farnesyl diphosphate (FPP), and geranylgeranyl diphosphate (GGPP) via the mevalonate pathway. These isoprenoids are used in posttranslational modification(prenylation) of small GTPases such as Ras, Rho, and Rac. These prenylated GTPases are necessary for various cellular processes including osteoclast morphology, endosome trafficking, and apoptosis. Alendronate has also been shown to impair the function of osteclast lysosomes.
The fraction of the drug that reaches the circulatory system intact (systemic bioavailability) after oral dosing is low, averaging only 0.6âÂÂ0.7% in women and in men under fasting conditions. Intake together with meals and beverages other than water further reduces the bioavailability. The absorbed drug rapidly partitions, with approximately 50% binding to the exposed bone surface; the remainder is excreted unchanged by the kidneys. Unlike with most drugs, the strong negative charge on the two phosphonate moieties limits oral bioavailability, and, in turn, the exposure to tissues other than bone is very low. After absorption in the bone, alendronate has an estimated terminal elimination half-life of 10 years.