Alendronate is a common medication for osteoporosis, but it can lead to every dentist’s nightmare – osteonecrosis of the jaw (ONJ). In addition to this rare but serious condition, Alendronate can cause dental-related side effects and has drug interactions with medications commonly prescribed in the dental office. Keep reading to find out more:
Generic Name: Alendronate
Brand Name(s): Fosamax
Pronunciation: a LEN dro nate
About this drug:
Alendronate is used to:
prevent and treat osteoporosis in women after menopause and in men and women with osteoporosis caused by long-term use of corticosteroids.
prevent a hip or spinal fracture.
increase bone mass in men who have osteoporosis.
treat Paget's disease of the bone.
Dentistry-related tidbits:
Alendronate may cause xerostomia. Consider prescribing a fluoride supplement if the patient has a high rate of caries and increasing the frequency of dental exams.
Alendronate may also cause taste changes.
A dental examination with appropriate preventive dentistry is recommended prior to treatment in patients with risk factors for ONJ such as invasive dental procedures, diagnosis of cancer, concomitant therapies (e.g. chemotherapy, corticosteroids), poor oral hygiene, and co-morbid disorders (e.g. diabetes). The risk of ONJ may increase with the duration of exposure to Alendronate.
Alendronate may cause hypocalcemia. Remind the patient if they are prescribed Calcium to not take more than directed to decrease the risk of kidney stones. Postmenopausal women require 1500 mg/day of Calcium and taking more has not demonstrated increased bone benefits plus may increase side effects.
Remind patients not to eat, drink, or lie down for at least 30 minutes after taking Alendronate. Mouth sores may occur if the medication tablet is chewed or dissolved in the mouth.
Combining aminoglycoside antibiotics such as Gentamicin with Alendronate may increase the risk of hypocalcemia.
Combining steroids and NSAIDs with Alendronate may increase the risk of upper GI ulceration, perforation, and bleeding, including serious bleeding. Before prescribing any medication, use the Rx Check tool to prevent potential drug interactions or adverse effects.
Fun facts:
Alendronate is part of the bisphosphonate class, which inhibits osteoclast activity, thus reducing bone resorption and turnover.
Patients are typically treated with Alendronate for 3-5 years, since it has a half-life of 10 years.
Alendronate was ranked as #103 most common prescription drug in the U.S., with over 6 million prescriptions written in 2022.
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