Last Edited: April 17th, 2012

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Your bones are in a constant state of remodeling; bone tissue is broken down and then rebuilt as calcium is transferred in and out of the bone matrix. As you grow older, less bone is rebuilt and the bones can become thinner and more susceptible to fractures, a condition called osteoporosis. Fosamax is a prescription medication that is used to treat or prevent osteoporosis.

How Fosamax Works

Animal studies show that Fosamax is incorporated into the bones and promotes new bone growth. It also decreases the rate at which bones turn over, so that remodeling can keep up with or exceed bone loss. Fosamax must be administered continuously to be effective. Fosamax may be ineffective if the patient doesn’t have sufficient calcium or vitamin D intake.


The dosage of Fosamax varies according to the medical condition for which it is prescribed. For treatment of osteoporosis in women who are past menopause or in men who have osteoporosis, Fosamax may be given in one 70 milligram dose once a week or as 10 milligrams a day. The dosage to prevent osteoporosis in postmenopausal women is 35 milligrams once a week or five milligrams once a day. Doses vary for other conditions, such as Paget’s disease or Glucocorticoid-Induced Osteoporosis. The drug should be taken on an empty stomach at least 30 minutes before you eat or drink anything but water and should be taken first thing in the morning with a full glass of water. Fosamax is available as tablets and a solution.

Side Effects

  • The most common side effects from Fosamax are gastrointestinal, and there is a risk that Fosamax may worsen gastrointestinal problems such as gastritis because it irritates the lining of the stomach. In some cases, Fosamax has caused ulcers and bleeding of the esophagus.
  • Small decreases in serum calcium and phosphate may occur during Fosamax administration, and patients should be treated for low calcium before Fosamax is administered.
  • Fosamax can cause severe and even incapacitating muscle, joint and bone pain. The drug should be discontinued if pain is severe.
  • Necrosis of the bone in the jaw has occurred in some patients taking Fosamax, and the drug should be discontinued prior to dental surgery.
  • Although they have not been directly linked to Fosamax, some patients have developed fractures in the femur in the absence of trauma.
  • Fosamax can cause allergic reactions.


  • Fosamax should not be given to people who cannot stand or sit upright for at least 30 minutes after the drug is administered, as lying down increases the risk of esophageal erosion and ulcers.
  • Patients who have hypocalcemia, or low serum calcium, should not take Fosamax until the hypocalcemia has been treated, and should take calcium supplements to prevent recurrence.
  • Fosamax is not recommended in patients with renal failure.
  • Patients who may aspirate should not take Fosamax oral solution.
  • People who do not get enough calcium in the diet or who are rarely exposed to sunshine should be supplemented with calcium and vitamin D.