Dear Pharmacist,

I take Fosamax every day for osteoporosis. It really upsets my

stomach but my doctor says I have to keep taking it. Is there a way

to help me with this?  A.L., Ocala, Florida

ANSWER:  Fosamax is the blockbuster drug created by Merck

& Co. but it notoriously causes heartburn, diarrhea, nausea and

stomach upset. Most osteoporosis drugs keep the bones at status

quo by preventing further bone loss. But because Fosamax can

actually build up bone mass and therefore, strengthen the bones, it

became  the gold standard of therapy.  Soon after, more drugs in this

class came out.  Since 2003, reports of osteonecrosis (bone death

in the jaw) have emerged so now, patients think twice about using

medications to build bone.

To minimize stomach upset, and the risk of ulceration don’t

take Fosamax at bedtime. Take it first thing in the morning. Take

it with a full glass of plain water, not mineral water, not juice, not

coffee or tea. Sit upright for at least 30 minutes to make sure the

tablet gets down into your gut. Do not chew or crush it. Also, ask

your doctor about long-acting Fosamax which allows you to take

one tablet each week, rather than a daily dose. The advantage to

slow release drugs is steadier coverage. That translates to fewer side

effects in the long run.  Today, we have Actonel taken weekly, and

Boniva taken monthly.