What’s the Story with Fosamax (Alendronate)? [in Lay Terms]

Armand Rossetti

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Laurie Carpenter posted the following comment about my recent Fosamax blog, "What's the Story with Fosamax (Alendronate):

"this info would be helpful if put into lay terms for patients being treated with Fosamax- I would appreciate more info in less medical terms."

I would like to make an effort to translate all of the jargon that pervades pharmaceutical and medical device industries. To be truthful, sometimes I have to look up a few of those words myself, and I have had a good amount of scientific and health care training.

Fosamax the Drug:

Fosamax is a chemical that finds its way to the bones, without depositing in other tissues in the body, like muscles or skin. When that chemical travels to the bone, it combines with bone tissue and fills in for bone that the body is dissolving and taking away. When the body takes bone away, but doesn’t make as much new bone to replace the lost bone, humans are left with a disease called osteoporosis (osteo meaning bone, and porosis, like porosity, meaning spaces).

Not all bone is alike, some bones, like the jaws have lots of plates that act as supports, and the jaw bone is specialized to hold teeth. Since we put a lot of pressure on the jaws, everyday, as we bite and chew food, the bone is specialized to deal with those daily assaults.

The chemical that is Fosamax doesn’t pick and choose what bones to combine with; it spreads itself throughout the human skeleton and does its job the same way everywhere.

How the Body Eliminates Fosamax:

When we take drugs like aspirin or penicillin, they do not remain in our body very long, only hours or days. This is because the body will break them down and eliminate them from our body. Fosamax is very different, because the body cannot change it and the body can only eliminate some of it. The rest of the Fosamax stays in the body’s skeleton for at least a decade and probably much longer.

If a patient keeps taking Fosamax for years, that chemical will keep accumulating in the bones, and scientists haven’t figured out a way to release it from the bone so that the body can eliminate it. Nobody really knows what effect the excess Fosamax might have on the system. Patients can stop taking Fosamax altogether, and five years later, the Fosamax that the patient took earlier is still working to interfere with the normal way the body works to take away old bone and replace it with new bone. It’s like not being able to stop a moving train.

It is possible that many patients and doctors do not realize that Fosamax stays around so long or that it is the gift that keeps on giving long after it has stayed its welcome.

How Fosamax Works:

If people are not trained as health care professionals, most will not realize that bone constantly changes shape, not by much, but it does it constantly. It’s called remodeling. Cells called osteoclasts (osteo meaning bone and clast meaning break down) chew up old bone, digest it into basic chemicals and those chemicals are transported to the bloodstream. When Osteoclasts break the bone down, they send signals to another separate set of cells called osteoblasts (blast meaning create) to make new bone. This process of breakdown and signaling for other cells to come in and rebuild is called coupling.

Fosamax belongs to a group of chemicals that can stop the cells that break down the bone. If the cells that break down bone cannot do their job or give any signals, the cells that rebuild bone are not being called in to do their job.

So Fosamax is not there to encourage bone remodeling. Fosamax is there to make the older denser bone remain, untouched by the coupling process. It is harder for the body to take minerals away from the older bone that is fortified with Fosamax. So the process of osteoporosis slows down to a crawl, and that’s a good thing.

Back to the jaw with specialized bone. Fosamax travels to the jaw bones and remains there as well. Doctors do not want to see Fosamax go to the jaws, but they have no choice in the matter. Jaw bone has more pronounced trabeculation (spaces surrounded by boney plates. Teeth are surrounded by a membrane. That membrane is surrounded by a specialized type of bone, and the jaws hold the teeth, membrane and specialized bone. The jaw is much different than the leg or even most of the hip.

If Fosamax interferes with the normal coupling process too much, it may be harmful, and scientists haven’t really figured out exactly how harmful. Too much of a “good” thing could actually weaken the bone by making it more brittle and less able to protect itself by remodeling.

Fosamax and its Interaction With the Jaw:

Scientists have found out that patients who take Fosamax for more than three and a half years can experience areas of bone death, little islands in the jaw, where bone is dying called osteonecrosis (osteo means bone and necrosis means process of dying). But the fact that Fosamax makes bone more brittle and stops the bone remodeling process may not be the only reason why the jaw containing Fosamax experiences areas of bone death.

Fosamax type chemicals are used to treat cancer and the reason why these chemicals are so efficient at treating cancer is that the chemicals stop tiny blood vessels that branch off of larger blood vessels from growing. That blood vessel growth is called angiogenesis (angio meaning blood vessel and genesis meaning birth).

If you can slow blood vessel growth, you can starve cancer cells. However, you can also starve the cells that work to keep bone alive.

Therefore, if you consider how long Fosamax stays in the bone, how it interferes with bone regeneration, how Fosamax interferes with bone repair, and how it slows blood vessel growth, you get an idea why Fosamax may not be very safe. The jaws have become the “Achilles heels” for Fosamax use.

I hope that this explanation has been helpful to you, Laurie. Our attorneys at Searcy Denney are always pleased to take the time to explain complex concepts to anyone who is interested. Thank you for your inquiry.