Question
My rheumatologist prescribed Fosamax for the treatment of osteoporosis. I was instructed to take one pill, once a week.

After about day five of the first week, I felt ill. It started out with a feeling of lethargy upon awakening in the morning and a sensation of turbulence in the area of my abdomen. Once out of bed, I felt nausea.

After my second dose on day one of week two, the symptoms returned within a matter of hours. Is there an explanation?

Answer
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Fosamax, along with Actonel, Boniva and others, is classified as a bisphosphonate. These medicines work by inhibiting bone removal. Unfortunately, while they’re excellent for treating osteoporosis, a well-known side effect is irritation of the esophagus and/or stomach. This may cause inflammation or an ulcer. Symptoms can include upper abdominal pain, heartburn and nausea.

Before you write it off completely, make sure you’re taking Fosamax correctly. Swallow the tablet with a glass of plain water first thing in the morning, before eating or drinking anything else. Then remain fully upright (standing, walking or sitting) for at least 30 minutes (or one hour for Boniva). During this time, avoid eating or drinking anything. After 30 minutes, you can lie down if you want, but eat breakfast first.

If you still have nausea, abdominal discomfort or heartburn when you follow those instructions, talk to your health-care provider about switching medications. (New or worsening heartburn, trouble swallowing and chest pain are some of the symptoms that should signal you to stop taking Fosamax immediately and contact your doctor.)

You can find out if you’re taking your bisphosphonate correctly through the patient information provided with your medication or the manufacturer’s Web site.

www.actonel.com
www.4boniva.com
www.fosamax.com

START OUT STRONG
One important way to prevent osteoporosis is to start out with strong bones in the first place. That way, you can afford to lose some bone when the normal aging process kicks in.

This is part of the reason men are less likely to get osteoporosis: They naturally have a higher bone density. It’s also an important reason for kids and teens to be active and get enough calcium and vitamin D. You build most of your bone before adulthood.

Board-certified internist KEVIN HWANG, M.D., is an instructor at the University of Texas Medical School at Houston.

Last updated and/or approved October 2007.
Original article appeared in summer 2007 issue.

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