Q&A: What are the pros and cons of alendronic acid?

Question:

“What are the pros and cons of taking alendronic acid?”

̶ Margie

Answer:

Dr Sarah Jarvis says: “Alendronic acid is used to treat osteoporosis, or thinning of the bones. It can be taken either as a 10 mg tablet every day or a weekly 70 mg tablet. The obvious benefit is that it works at lowering your risk of progression of osteoporosis, which is a major problem for women in particular. Over 1/3 of women and one in five men will break a bone at some point as a result of osteoporosis. It gets more common as you get older (particularly after the menopause), and is also more common in people taking long-term steroid tablets; women who went through an early menopause or have had absent periods for more than six months before the menopause (eg because of anorexia); smokers; drinkers or more than four units a day; people with inflammatory bowel disease, overactive thyroid, rheumatoid arthritis, coeliac disease, type 1 diabetes or chronic kidney or liver disease; or if a parent or sibling has osteoporosis.

Alendronic acid has to be taken in a very specific way. You have to swallow it whole (with water), without chewing, at least 30 minutes before you eat in the morning. You then need to avoid lying down for at least half an hour after this.

The most common side effect of alendronate is indigestion/heartburn, although wind, diarrhoea, constipation, and headache can also occur. Less commonly, it can give rise to more severe inflammation in the stomach and gullet (oesophagus), including ulcers. A rare complication is osteonecrosis of the jaw, where the bone in the jaw is eaten away. It can give rise to loosening teeth or jaw pain with pain or swelling.

One of the current big question marks in terms of treatment with alendronate is how long you should keep taking it for. There are few studies looking at treatment for longer than three to five years, and a recent review by the British Medical Journal said that in patients who aren’t at extremely high risk because of very low bone density, or who don’t have specific reasons for continuing, such as breaking a bone despite being on treatment, it is ‘reasonable’ to discontinue bisphosphonates after three to five years.

This is clearly a discussion for you to have with your doctor. Lots of my patients are very worried about the side effects of preventative medications, but they often forget that there are risks of not taking these medicines, too.”

̶ Dr Sarah Jarvis