I’m curious about how Fosamax works to increase bone density and why there are certain important considerations in how to take it.
Disclaimer - I’ve just started taking this stuff, and I’m under a doctor’s care following his instructions. I’m not asking for advice. It’s just gotten me curious, is all.
So, you take this pill first thing in the morning with plenty of water and nothing else for at least a half hour, during which you have to remain standing. Since bones regulate their density partly in response to the stress they experience, I assume Fosamax is amplifying or building on the response somehow.
But, just a half hour? That isn’t very much time for a drug to get into your system, is it? Especially, since bone is pretty slow growing, pretty metabolically quiet, does it really do that much during the half hour after swallowing a tablet?
And, why can’t you eat or drink anything else? Some drugs don’t work if you eat specific things, like Levaquin (an antibiotic) not working if you eat magnesium compounds (like stomach remedies) at nearly the same time. But is Fosamax somehow sensitive to ALL other foods?
And, standing stresses certain bones that are important, but what about all the others? Collarbones are pretty easy to break, and bones in the hands and arms are often broken (they’re in a busy spot). Following directions doesn’t do anything to stress these bones. Does Fosamax do them any good?
Finally, the instructions suggest that the longer you wait to eat anything else or stop standing, the better, at least on a 1 or 2 hour timescale. Does the stuff decay exponentially in its effect? What’s the time constant?
Judging by what I’ve heard about it (IANAD/N, but I do work in medical research), it sounds like Fosamax may cause/aggravate esophageal ulcers if you lie down or recline and allow the chance for acid reflux to “wash” the medication up into the esophagus. Warning you to not take anything else with it is probably to promote as rapid as possible of progress of the medication in digestion and (assuming it works this way) into the intestines for absorption. I googled and found an article here which has a fairly simple description of what exactly the drug does.
The competing osteoporosis commercials promote how infrequently you need to take the drug, which may be a big bonus for people who do have trouble standing for that period of time - doing that less frequently is a good selling point for them.
*Fosamax works by inhibiting the work of osteoclats.
Osteoclats are the cells that remove old bone. Fosamax does not affect the work of your osteblats, the cells that build new bone. Since your osteoblats continue to work while your osteoclats are inhibited by the drug, you begin to add bone.
First you stop losing more bone than your cells are making. Then slowly, you begin to add new bone. If you are doing bone density exercises and other bone building activities, you will build new bone faster.*
An on-line friend says her mother died from a bleeding esophageal ulcer caused by Fosamax. I was careful in following the directions before, but after hearing that, I started drinking two glasses of water with the drug.
If you read the small print in the folder that comes with the scrip, it says no food or drink for two to three hours is better. The 30 minutes is the minimum. I suspect that’s why someone might want to switch to Boniva, the once-monthly drug. It’s really hard to wait three hours for food in the a.m., and it’d make a lot of people light-headed.
It’s a trade-off I can live with. I’ve had two bone density tests. The first showed “high risk for fracture”. I took Fosamax for about a year and then lost my insurance coverage. There was no generic at the time and the drug cost more than I could afford to pay. I made do (or thought I did) with calcium supplements and then broke a hip. A year after the break, I had insurance again and restarted the Fosamax. A second bone density test showed “slight improvement”. That was about two years ago. I fell a couple weeks ago, landed hard and didn’t break anything. Not a scientific test but it did make me feel better.
I’ll definitely keep on top of this with my doctor. And thank heaven for generics – the scrip is less than $20 a month, and it used to be almost $100 (for four pills).
Necrosis is pretty freaking rare, I’ll add here. I’ll also note that it’s not your whole bone, but the joint. I’ve seen a patient who had necrosis in three major joints and had never taken Fosamax or a similar medication, and had very successful joint replacement surgery.
If you have concerns about your medications, please ask your doctor about the relative risks of using such medications. (I’ll also note that a “lawyers and settlements” site may well be hyping up the risk of something for less-than-noble reasons. )
Mmmm. Well, not getting old sucks worse.
Thanks for all these leads. I will look further.
I read a lot about the gastric upset problem and can imagine they don’t want you lying down, but most people would be inclined to sit, not stand. The instructions are very specific about standing. Reflux isn’t any better standing than sitting, is it? Well, unless you have a big enough belly. I mean, I do, but they weren’t eyeing me when they wrote the instructions. I hear most of the people using this drug are slender. Including before they started, I mean.
My instructions say to sit or stand, but I’m skinny, if that makes a difference. Is our stomach in a different place if we’re heavy? Closer to the esophagus? I never took anatomy. All I know about innards I learned from the drawing in the old Pepto Bismol commercial.
Ferret Herder, I’ve calmed down some. The articles are scary, but the word “rare” makes me feel better.
Disclaimer: I am a pharmacist, however, not knowing you or your medical history, I cannot give medical advice directly. Consult your doctor or local pharmacist for medical advice.
Others have already commented on this, but in a nutshell, Fosamax (alendronate) and other bisphosphonates (Boniva, Actonel) prevent osteoclasts (cells in your bone which breakdown the hard bone structure) from doing their job. The drug gets absorbed into your blood and then mixed into the hard bone matrix. When the bone-breakdown cells (osteoclasts) “eat” alendronate, they stop working.
In a nutshell, we ask that you take it in the morning, first thing, to optimize how much of the drug gets absorbed. Bisphosphonates (the class of drug to which Fosamax belongs) are generally very poorly absorbed, and food of almost any kind reduces or altogether eliminates their absorption. Half an hour is generally recommended because most people don’t want to wait much longer after waking before eating breakfast and while absorption of the drug is reduced, enough is still absorbed to work. Optimally, based on the studies I’ve read, one has to wait 2 hours before no effect on absorption is noticeable. Practically, though, compliance would be incredibly low-to-nonexistent if we asked you to wait that long before eating.
As for the standing portion of your comment, you don’t need to be standing, merely sitting up. The key is to lessen the chances your gastric contents will reflux back out of your stomach and irritate (and potentially ulcerate) your lower esophagus. An upright position is optimal for this, be it seated or standing.
Sadly, all of the oral bisphosphonates suffer from poor absorption, which is worsened by all kinds of food. Other drugs have issues similar to this (levothyroxine is notorious for this).
Based on clinical evidence, Fosamax does have an effect all over your body, though I was taught it is greatest in the hip bones, and the spine (and by greatest, I mean, clinically relevant, beyond just being statistically relevant).
It’s not really a decay factor, so much as any sooner, based on clinical trials, and the interaction between food particles and solubilized drug particles is enough to reduce the drug’s bioavailability (roughly, the body’s ability to absorb usable drug into the bloodstream).
Your stomach is directly connected to the esophagus. It’s no closer or farther away whether you are skinny or obese. The function of your LES (lower esophageal sphincter) may be affected by obesity (I’m honestly not sure), but anatomically, there should be no differences.
I refer to big bellies and reflux because they are related by the extra abdominal pressure a big belly can cause. Being fat often means the clothes are tighter, and especially so when sitting. Anything that tries to crowd more flesh into the space that is mostly surrounded or constrained by pelvis and spine and lower ribcage is also going to make reflux liklier.