Pre-Treatment Evaluation for Fosamax (Alendronate) Therapy

Essential Laboratory Tests and Dental Assessment

• The American Society of Clinical Oncology recommends that patients have serum calcium measured and undergo a dental assessment prior to starting Fosamax (alendronate) therapy, as hypocalcemia is a contraindication and must be corrected before initiating therapy, and the risk of osteonecrosis of the jaw (ONJ) increases with frequency, dose, and duration of bisphosphonate administration 1
• For patients receiving intravenous bisphosphonates, more extensive monitoring is required, including renal function prior to starting treatment and monitoring of serum calcium and serum creatinine throughout the treatment period, with a recommended creatinine clearance of at least 35 mL/min 1
• Any pending dental or oral health problems should be addressed before starting treatment when possible, to minimize the risk of ONJ, particularly with tooth extractions and other invasive dental procedures 2

Bone Health Evaluation and Supplementation

• The Haematologica society recommends evaluating bone mineral density using dual-energy X-ray absorptiometry (DXA) in patients with risk factors for osteoporosis, particularly when other risk factors for osteoporosis are present 3
• Calcium and vitamin D supplementation is recommended unless otherwise contraindicated, with oral bisphosphonates and calcium separated by at least 2 hours to allow for maximum absorption 1