Binosto, Fosamax (Alendronate) - Oral

What Is Alendronate?

Alendronate, under the brand name Binosto, is an oral prescription tablet used to treat osteoporosis (soft, brittle bones) in females after menopause or increase bone mass in males with osteoporosis.

In addition to the above uses, alendronate is also available under the brand name Fosamax to prevent osteoporosis, treat Paget's disease (a bone disorder), and treat glucocorticoid-induced osteoporosis.

Alendronate belongs to a drug class called bisphosphonates. These drugs help slow down bone resorption. Bone resorption is the destruction of the tissue that causes bone loss.

Binosto is available as an oral effervescent tablet, which is designed to dissolve when in contact with liquid. Fosamax is available as a 70-milligram (mg) tablet. Binosto and Fosamax share the same active ingredient, alendronate. Alendronate is also available generically in oral solution (liquid) form.

Drug Facts

Generic Name: Alendronate

Brand Name(s): Binosto, Fosamax

Drug Availability: Prescription

Administration Route: Oral

Therapeutic Classification: Calcium regulator

Available Generically: No (Binosto), Yes (Fosamax)

Controlled Substance: N/A

Active Ingredient: Alendronate

Dosage Form(s): Effervescent tablet (Binosto), tablet (Fosamax), solution (generic only)

What Is Alendronate Used For?

The Food and Drug Administration (FDA) approved Binosto to:

  • Treat osteoporosis (soft, brittle bones)
  • Increase bone mass in males with osteoporosis

Osteoclasts and osteoblasts are the two main types of bone cells that work together to promote the process of bone resorption (breakdown of bone tissue) and bone formation. However, too much osteoclast activity can cause excessive bone breakdown. Alendronate slows osteoclast formation to help reduce bone breakdown.

Fosamax, another brand name with the same active ingredient (alendronate) as Binosto, is approved to:

  • Treat Paget’s disease, a bone disorder that causes accelerated bone growth and leads to tumors and increased bleeding due to fractures
  • Treat and prevent osteoporosis in postmenopausal women
  • Increase bone mass in males with osteoporosis
  • Treat osteoporosis caused by glucocorticoids (steroids)

How to Take Alendronate

Take one dose by mouth as prescribed, usually once weekly or daily. Take your dose at the start of the day, at least 30 minutes before your first food, drink, or other medications. To prevent irritation of the esophagus, keep upright and do not lie down for at least 30 minutes after taking your dose and until after you have had your first meal of the day.

Follow these general guidelines for taking each dosage form:

  • Effervescent tablet: Dissolve the effervescent tablet in 4 ounces (120 milliliters) of room-temperature plain water only (not mineral or flavored water). Taking it with other drinks and food may lower the amount your body absorbs. You will see it give off bubbles. Wait for at least five minutes after the bubbling stops, then stir for 10 seconds before drinking it.
  • Tablet: Take the tablet with 6 to 8 ounces of plain water. Do not chew or suck on the tablet, as this can irritate the mouth.
  • Solution: After taking the solution, drink at least 2 ounces of water.


Store this medication at room temperature (68 to 77 degrees F). You may store it between cool and mildly hot temperatures (59 to 86 F) for brief periods. Keep it away from moisture; do not store it in the bathroom. Leave tablets in the original blister package until use. Keep out of reach of children and pets.

Toss any unused or expired drugs. Do not throw your medicine down the toilet, sink, or drain. Ask your pharmacist about the best ways to discard your medication. Check out local drug take-back programs in your area.

Off-Label Uses

Healthcare providers may prescribe alendronate for off-label uses, meaning for conditions not specifically indicated by the FDA.

Off-label alendronate is used to prevent osteoporosis caused by:

  • Glucocorticoids or steroids like prednisolone
  • Androgen deprivation therapy for prostate cancer treatment (e.g., leuprolide)

Rarely, it may be used in children to treat:

However, there is not enough evidence to determine the long-term safety and efficacy of biphosphonates in children.

How Long Does Alendronate Take to Work?

After taking alendronate, it temporarily stays in the soft tissues before quickly moving to the bone or being eliminated in the urine. It can take three months or longer to improve your bone density.

What Are the Side Effects of Alendronate?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider. You may report side effects to the FDA at or 1-800-FDA-1088.

Common Side Effects

Any drug may cause side effects. However, some people taking alendronate may experience little or no adverse effects. Notify your healthcare provider or get medical treatment if you have any concerning or persistent side effects.

Common side effects can include:

These are only a few of the drug's possible side effects. If you have any concerns about side effects, contact your healthcare provider.

Severe Side Effects

Call your healthcare provider immediately if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and symptoms can include the following:

  • Stomach ulcers (abdominal pain or discomfort, bloating, heartburn, and nausea)
  • Heartburn (burning sensation in chest or throat, sour or bitter taste in the mouth, and difficulty swallowing)
  • Mouth sores
  • Severe bone, joint, or muscle pain
  • Muscle cramps or spasms
  • Swallowing difficulties
  • Atypical femur fractures (see a healthcare provider if you have new thigh or groin pain)
  • Jaw pain or swelling
  • Allergic reaction (hives (urticaria), rash, or swelling)

Report Side Effects

Alendronate may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Alendronate Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (effervescent tablets):
    • For treatment of osteoporosis in men:
      • Adults—70 milligrams (mg) once a week at least 30 minutes before the first food or drink of the day other than water.
      • Children—Use is not recommended.
    • For treatment of postmenopausal osteoporosis:
      • Adults—70 milligrams (mg) once a week at least 30 minutes before the first food or drink of the day other than water.
      • Children—Use is not recommended.
  • For oral dosage forms (liquid or tablets):
    • For treatment of corticosteroid-induced osteoporosis:
      • Adults—5 milligrams (mg) once a day at least 30 minutes before the first food or drink of the day other than water. In postmenopausal women not receiving estrogen, the dose is 10 mg once a day.
      • Children—Use is not recommended.
    • For treatment of Paget's disease of bone:
      • Adults—40 milligrams (mg) once a day for 6 months. Your doctor may tell you to repeat this dose.
      • Children—Use is not recommended.
    • For treatment of osteoporosis in men:
      • Adults—10 milligrams (mg) once a day or 70 mg once a week at least 30 minutes before the first food or drink of the day other than water.
      • Children—Use is not recommended.
    • For treatment of postmenopausal osteoporosis:
      • Adults—10 milligrams (mg) once a day or 70 mg once a week at least 30 minutes before the first food or drink of the day other than water.
      • Children—Use is not recommended. .
    • For prevention of postmenopausal osteoporosis:
      • Adults—5 milligrams (mg) once a day or 35 mg once a week at least 30 minutes before the first food or drink of the day other than water.
      • Children—Use is not recommended.


Dosage or treatment adjustments may be required for the following:

  • Pregnancy: Not enough data is available to know whether this medication is safe to use while pregnant. It's recommended to stop taking alendronate if you become pregnant. Notify your healthcare provider immediately if you are or suspect you may be pregnant.
  • Breastfeeding: It is unknown whether this drug passes in breast milk or would affect a nursing infant. If you are breastfeeding or plan to breastfeed, discuss the best course of action with your healthcare provider.
  • Kidney problems: You may need to discontinue treatment if you experience a certain level of kidney impairment. Talk to your healthcare provider if you have had past kidney problems.

Missed Dose

If you miss your once-weekly dosing, take it the following morning. Return to the regular dosing schedule of once a week. Do not take extra or two doses at a time.

Overdose: What Happens If I Take Too Much Alendronate?

Overdose symptoms may include:

Call your healthcare provider if you experience these side effects.

Taking antacids or milk may reduce the effects of alendronate. To prevent more esophageal irritation, do not force yourself to vomit. Always stay upright.

What Happens If I Overdose on Alendronate?

If you think you or someone else may have overdosed on alendronate, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking alendronate, call 911 immediately.


Drug Content Provided and Reviewed by IBM Micromedex®

If you will be taking this medicine for a long time, it is very important that your doctor check your progress at regular visits to make sure this medicine is working properly and watch for unwanted effects.

This medicine can irritate your esophagus. Call your doctor right away if you think this medicine has started to damage your esophagus. Some symptoms of damage to the esophagus are heartburn (either new or worse than usual), pain when swallowing, pain in the center of your chest, trouble swallowing, or feeling that food gets stuck on the way to your stomach.

It is important that you tell all of your health care providers that you are taking alendronate. If you are having a dental procedure while taking alendronate, you may have an increased chance of having a severe problem with your jaw.

Make sure you tell your doctor about any new medical problems, especially with your teeth or jaws. Tell your doctor if you have severe bone, joint, or muscle pain while using this medicine.

This medicine could lower the amount of calcium in your blood. Call your doctor right away if you develop any signs of low calcium levels, such as muscle spasms or twitching, or numbness or tingling in your fingers, toes, or lips.

This medicine may increase your risk of developing fractures of the thigh bone. This may be more common if you use it for a long time. Check with your doctor right away if you have a dull or aching pain in the thighs, groin, or hips.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Alendronate?

Do not take alendronate if you have:

What Other Medications Interact With Alendronate?

Other drugs can interact with alendronate. Talk with your healthcare provider about any other medicines you take or plan to take, including over-the-counter (OTC) drugs, prescription medications, vitamins, herbs, or plant-based products.

Avoid taking alendronate and parathyroid hormones together. Alendronate lowers their effects. Parathyroid hormone therapy is typically used to help treat low levels of calcium in the blood in people with certain types of hypoparathyroidism.

Additionally, taking calcium supplements and antacids with alendronate can interfere with the absorption of alendronate. Wait at least 30 minutes after taking alendronate to take calcium or antacids.

What Medications Are Similar?

Medications similar to alendronate that may be used to treat or prevent osteoporosis are:

You may take risedronate and alendronate once every week. Both drugs have similar efficacy and side effect profiles. Ibandronate is usually taken once every month.

Reclast is given every 12 or 24 months for osteoporosis treatment and prevention, respectively. It may work better in increasing bone density than alendronate in some people.

This is a list of drugs also prescribed to treat or prevent osteoporosis. It is NOT a list of medicines recommended to take with alendronate. Do not take these drugs together unless your healthcare provider tells you to. Talk to your healthcare provider or pharmacist if you have any questions about your treatment.

Frequently Asked Questions

  • What is alendronate used to treat?

    Binosto is commonly used to treat osteoporosis in postmenopausal women and improve bone mass in males with osteoporosis. Alendronate is also approved under the brand name Fosamax to treat the same conditions, but it is also used to prevent osteoporosis, treat glucocorticoid-induced osteoporisis, and treat Paget’s disease. Fosamax is also available generically in oral solution form.

  • What are the common side effects of alendronate?

    The common side effects of alendronate include upper gastrointestinal reactions (e.g., heartburn, indigestion), stomach pain, constipation, diarrhea, headache, and nausea.

  • What should I do if I miss a dose of alendronate?

    If a once-weekly dose is missed, take the missed dose the following morning once you remember. Return to your normal scheduled day of the week for your once-weekly dosing. Do not take extra or double your amount.

  • How long should I stay upright after taking alendronate?

    Keep upright and do not lie down for at least 30 minutes and until after you have had your first meal of the day. Doing this will reduce the risk of having esophageal irritation.

  • Can I mix alendronate in orange juice?

    No, you should only mix the effervescent tablet with room-temperature, regular water. Mixing it with other drinks and food may lower the amount of medicine absorbed in your body.

How Can I Stay Healthy While Taking Alendronate?

Taking adequate calcium and vitamin D is vital for your bone health. Use the daily recommended amount of calcium and vitamin D. The recommended amount varies by age, sex, and other factors. Generally, it is recommended to try and meet your recommended daily amount through food first.

Calcium-rich foods include:

  • Dairy products, such as ricotta, yogurt, and milk
  • Seafood, such as sardines, salmon, and shrimp
  • Fortified foods, like almond or soy milk, orange or other fruit juices, oatmeal, and cereal

Food sources of vitamin D include:

  • Protein, such as rainbow trout, salmon, and tuna
  • Dairy and fortified foods, like soy or cow milk and yogurt
  • Mushrooms
  • Orange juice

Check the food label to determine what nutrients are in a particular product.

If you have difficulty achieving adequate calcium and vitamin D intake through food alone, OTC supplements are available. Always consult your healthcare provider before starting any new supplements.

Weight-bearing (e.g., walking, hiking) and resistance exercises (e.g., lifting weights) are also beneficial for bone health. Check with your healthcare provider before beginning a regular exercise plan.

Contact your healthcare provider if you have any concerns or questions. Do not start, stop, or adjust any medicine, including OTC supplements, without talking to your healthcare provider.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Food and Drug Administration. Binosto label.

  2. Food and Drug Administration. Fosamax label.

  3. Cremers S, Drake MT, Ebetino FH, et al Pharmacology of bisphosphonates. 2019;85(6):1052-1062. doi:10.1111/bcp.13867

  4. Chen X, Wang Z, Duan N, et al. Osteoblast-osteoclast interactions. Connect Tissue Res. 2018;59(2):99-107. doi:10.1080/03008207.2017.1290085

  5. Prescribers' Digital Reference. Alendronate sodium - drug summary.

  6. Kan SL, Yuan ZF, Li Y, et al. Alendronate prevents glucocorticoid-induced osteoporosis in patients with rheumatic diseases: A meta-analysis. Medicine (Baltimore). 2016;95(25):e3990. doi:10.1097/MD.0000000000003990

  7. Bienz M, Saad F. Androgen-deprivation therapy and bone loss in prostate cancer patients: a clinical review. Bonekey Rep. 2015;4:716. doi:10.1038/bonekey.2015.85

  8. Eghbali-Fatourechi G. Bisphosphonate therapy in pediatric patients. J Diabetes Metab Disord. 2014;13(1):109. doi:10.1186/s40200-014-0109-y

  9. MedlinePlus. Alendronate.

  10. Finkelstein JS, Hayes A, Hunzelman JL, et al. The effects of parathyroid hormone, alendronate, or both in men with osteoporosis. N Engl J Med. 2003;349(13):1216-1226. doi:10.1056/NEJMoa035725

  11. MedlinePlus. Parathyroid hormone injection.

  12. Emkey R. Alendronate and risedronate for the treatment of postmenopausal osteoporosis: clinical profiles of the once-weekly and once-daily dosing formulations. MedGenMed. 2004;6(3):6.

  13. Guañabens N, Monegal A, Cerdá D, et al. Randomized trial comparing monthly ibandronate and weekly alendronate for osteoporosis in patients with primary biliary cirrhosis. Hepatology. 2013;58(6):2070-2078. doi:10.1002/hep.26466

  14. Shane E, Cohen A, Stein EM, et al. Zoledronic acid versus alendronate for the prevention of bone loss after heart or liver transplantation. J Clin Endocrinol Metab. 2012;97(12):4481-4490. doi:10.1210/jc.2012-2804

  15. Bone Health & Osteoporosis Foundation. A guide to calcium-rich foods.

  16. Dietary Guidelines for Americans. Food sources of vitamin D.

  17. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Exercise for your bone health.

By Queen Buyalos, PharmD
Queen Buyalos is a pharmacist and freelance medical writer. She takes pride in advocating for cancer prevention, overall health, and mental health education. Queen enjoys counseling and educating patients about drug therapy and translating complex ideas into simple language.