Alendronate precautions

List of precautions
General Hypocalcemia Renal Insufficiency Bone mineral density

General
Causes of osteoporosis other than estrogen deficiency, aging, and glucocorticoid use should be considered. Return to top

Hypocalcemia
Hypocalcemia must be corrected before initiating therapy with FOSAMAX. Other disturbances of mineral metabolism (such as vitamin D deficiency) should also be effectively treated. Presumably due to the effects ofFOSAMAX on increasing bone mineral, small, asymptomatic decreases in serum calcium and phosphate may occur, especially in patients with Paget's disease, in whom the pretreatment rate of bone turnover may be greatly elevated and in patients receiving glucocorticoids, in whom calcium absorption may be decreased. Ensuring adequate calcium and vitamin D intake is especially important in patients with Paget's disease of bone and in patients receiving glucocorticoids. Return to top

Renal Insufficiency
FOSAMAX is not recommended for patients with renal insufficiency (creatinine clearance <35 mL/min). Glucocorticoid-induced osteoporosis The risk versus benefit of FOSAMAX for treatment at daily dosages of glucocorticoids less than 7.5 mg of prednisone or equivalent has not been established. Before initiating treatment, the hormonal status of both men and women should be ascertained and appropriate replacement considered. Return to top

Bone mineral density
A bone mineral density measurement should be made at the initiation of therapy and repeated after 6 to 12 months of combined FOSAMAX and glucocorticoid treatment. Return to top