Treatment of Osteopenia with Fosamax (Alendronate)

Evidence-Based Recommendations for Osteopenia

The American College of Physicians recommends that clinicians should make the decision whether to treat osteopenic women 65 years of age or older who are at high risk for fracture based on a discussion of patient preferences, fracture risk profile, and benefits, harms, and costs of medications (Grade: weak recommendation; low-quality evidence) 1, 2
Treatment should be considered in women with a 10-year risk of major osteoporotic fracture of at least 20% or a risk of hip fracture of at least 3% according to FRAX calculations 3, 4
Treatment should also be considered in patients who have had a low-trauma fracture, even if DEXA does not indicate osteoporosis 3, 4
Studies directly addressing the efficacy of pharmacologic treatments for reducing fractures specifically in patients with osteopenia are lacking and more research is needed 1, 5

Alendronate is FDA-approved for the prevention of osteoporosis at a dose of 5 mg per day or 35 mg per week 3

Rare but serious adverse events include atypical subtrochanteric fractures and osteonecrosis of the jaw 2
Contraindications include abnormalities of the esophagus 3, inability to stand or sit upright for at least 30 minutes 3, hypocalcemia 2, and hypersensitivity to any component of the product 3

Assess fracture risk in osteopenic patients using FRAX score calculation 3, 2 and history of previous fractures 3, 4
Consider alendronate for osteopenic patients if 10-year risk of major osteoporotic fracture ≥20% 3, 4, 10-year risk of hip fracture ≥3% 3, 4, or history of low-trauma fracture 3, 4
The ACP recommends against bone density monitoring during the 5-year pharmacologic treatment period 1, 2
Treatment duration should typically be 5 years 2