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bisphosphonate
Strengthens bone and reduces the risk of fracture. This molecule appears in 160 of the medicines we have indexed.
We do not make a formula for this treatment. Talk to your doctor or pharmacist about these active ingredients.
See the detailsBy the Layer Nutrition editorial teamHow the atlas classifies the 664 molecules
Pharmacologically, this molecule belongs to the “bisphosphonate (osteoporosis)” category. This medicine strengthens the solidity of the bone and reduces the risk of fracture.
In practice: Strengthens bone and reduces the risk of fracture. It is generally taken over the long term, with regular follow-up, and it is not stopped on one’s own initiative.
These names come from the public registers of 32 countries: the ANSM for France, the AEMPS for Spain, the AIFA for Italy, the HPRA for Ireland, Swissmedic for Switzerland, and the European Medicines Agency for the others.
Most widespread
No name matches.
The atlas gives each molecule one of these three answers. Most call for nothing.
The treatment acts on bone, but bone needs raw materials. Calcium builds its mineral framework and vitamin D governs its absorption in the intestine. Food provides both, meal after meal.
Calcium is found first in dairy products: yogurt and cheese. Sardines and canned salmon eaten with their bones supply generous amounts, as do kale and broccoli. These foods cover a good share of the skeleton’s daily needs.
Vitamin D promotes the intestinal absorption of calcium. It is found mainly in oily fish, salmon, sardines and mackerel, as well as in egg yolk and mushrooms exposed to UV light. Bringing these foods together over the course of the week supports bone.
Alendronate belongs to the family of nitrogen-containing bisphosphonates. Once in the bloodstream, it binds to the hydroxyapatite crystals that form the mineral of bone, particularly where the tissue is undergoing active resorption. This strong affinity for the skeleton explains its targeted action on bone rather than on the rest of the body.
On site, it enters the osteoclast, the cell responsible for breaking down the bone matrix. Inside, it inhibits an enzyme of the mevalonate pathway, farnesyl pyrophosphate synthase, which is essential for the osteoclast’s attachment to the bone surface. Deprived of this anchoring, the osteoclast detaches and its resorptive activity slows. The breakdown of the bone matrix decreases, which gives the tissue time to rebuild.
Alendronate is indicated for the treatment and prevention of postmenopausal osteoporosis. It is also used to increase bone mass in men with osteoporosis, to treat corticosteroid-induced osteoporosis and Paget’s disease of bone. The common thread in these situations is bone that breaks down faster than it rebuilds.
By slowing resorption, alendronate prevents bone loss and increases the mineral density of bone. Denser bone withstands stress better and breaks less easily. Reducing the risk of fracture is the ultimate goal of treatment, and it is against this horizon that its value is judged.
The tablet is taken in the morning, right after getting up, on an empty stomach, at least 30 minutes before the first food, the first drink or any other medication. It must be swallowed with a large glass of still water, 180 to 240 mL, and never with coffee, tea, juice, mineral water or milk, because these drinks reduce its already low absorption. After taking it, you must stay standing or sitting upright, without lying down, for at least 30 minutes and until the first meal, to limit irritation of the esophagus.
This discipline in dosing determines the effectiveness: taken incorrectly, the tablet does not pass through and does not work. The treatment is a long-term one and should not be stopped on your own initiative, even if the bone gives no sign of trouble. The terminal half-life of alendronate exceeds ten years, because it is released very slowly from the skeleton: its effect sets in and continues well beyond each dose.
The most frequent effects involve the upper digestive tract. In clinical trials, abdominal pain was reported in 1.5 to 6.6 % of patients, acid regurgitation in 1.1 to 4.3 %, dyspepsia in 1.1 to 3.6 % and nausea in 1.1 to 4.0 %. Esophageal ulcer remained rarer, from 0 to 1.5 %, and musculoskeletal pain affected 0.3 to 4.1 % of patients. These figures explain the dosing instructions, which aim to protect the esophagus.
Osteonecrosis of the jaw occurs with an incidence of about 1 in 10,000 to 1 in 100,000 in patients treated for osteoporosis, often after a tooth extraction or a local infection, which justifies dental monitoring. Atypical femoral fracture, in the shaft or the subtrochanteric region, may appear after prolonged treatment and should be considered when there is unusual thigh pain.
Alendronate slows the destruction of bone, but mineral reconstruction needs available calcium. This is why hypocalcemia is a contraindication: it must be corrected before starting treatment. A vitamin D deficiency warrants supplementation before and during use, because vitamin D governs the body’s calcium homeostasis.
Vitamin D promotes the intestinal absorption of calcium: without it, the calcium supplied is poorly used. An adequate intake of calcium remains necessary for bone health throughout the treatment as well. This nutritional foundation accompanies the medication, in addition to your treatment and never in place of it, and food is its first supplier.
Calcium, antacids and medications containing polyvalent cations, such as calcium, magnesium, iron or aluminum, reduce the absorption of alendronate: their intake must be spaced apart from that of the tablet. Caution is also recommended with aspirin and non-steroidal anti-inflammatory drugs, because of an increased risk of gastrointestinal irritation when they are combined.
Laboratory monitoring frames the treatment. It includes serum calcium and bone mineral density at the outset, then a check at 6 to 12 months, with monitoring of magnesium and phosphorus. Alendronate is not advised in cases of severe renal impairment, below a creatinine clearance of 35 mL/min, which means checking kidney function before prescribing it.
Beyond the plate, a single isolated nutrient can be worth discussing, to confirm with your doctor or pharmacist. Here is which one and in which form.
Calcium is the most abundant mineral in the body, involved in bone health. Calcium citrate is well absorbed, including away from meals, whereas carbonate requires an acidic environment for its absorption.
Preferred formcalcium citrate (does not depend on gastric acidity)
To be confirmed with your doctor or pharmacist.
Vitamin D is a fat-soluble vitamin. The D3 form (cholecalciferol) is the one adopted by most guidelines. It is better absorbed when taken during a meal that contains fats.
Preferred formD3 (cholecalciferol), during a fatty meal
To be confirmed with your doctor or pharmacist.
Type the name written on the box. The atlas gives you its answer.
For example Panadol, Doliprane or paracetamol.
According to the leaflet, alendronate is taken on an empty stomach, first thing in the morning, swallowed whole with a large glass of plain water, while staying standing or sitting for a while before eating or drinking anything else. For the exact schedule that applies to you, refer to your medicine’s leaflet and follow the advice of your doctor or pharmacist.
The leaflet notably mentions digestive problems and irritation of the oesophagus or stomach, which is why the way it is taken is so specific. The complete list and the frequency of these effects are given in the leaflet. If you experience discomfort or pain, talk to your doctor or pharmacist.
No: the leaflet states that calcium, supplements, antacids and food reduce the absorption of alendronate when they are taken too close together, and it recommends spacing them out. The precise timing of your various doses should be set with your doctor or pharmacist.
Alendronate is an osteoporosis treatment reserved for very specific situations, and the leaflet includes specific warnings regarding pregnancy and breastfeeding. This decision rests with your doctor: tell them about any current or planned pregnancy before any treatment.
The leaflet for alendronic acid notes that an adequate intake of calcium and vitamin D is important during this type of treatment, as these two nutrients contribute to the maintenance of normal bone. That is the nutritional angle to consider, while monitoring your status with the professional who follows you.
For calcium, calcium citrate is a form reputed to be well absorbed, including outside of meals. For vitamin D, vitamin D3 (cholecalciferol) is the form best used by the body. The key is still to space these intakes apart from taking the medicine, as the leaflet reminds you.
These answers draw on the patient leaflet and on the published literature. For any question about your medicine, the patient leaflet and your doctor or pharmacist are the reference.
We will write to you the day your formula becomes available.