Alendronate: How to Take It, Side Effects, and Practical Tips

Alendronate is a commonly prescribed bisphosphonate used to prevent and treat osteoporosis. It helps slow bone breakdown and lowers your risk of spine and hip fractures. This short guide focuses on the things patients need to know: how to take alendronate correctly, common side effects, interactions, and simple safety steps you can use every day.

Take alendronate first thing in the morning on an empty stomach. Swallow the tablet whole with a full glass (200–250 ml) of plain water. Do not take it with coffee, juice, or any food. Stay upright—sitting or standing—for at least 30 minutes after you take the pill. Don’t lie down or go back to bed right away. Wait a minimum of 30 minutes before eating, drinking anything other than water, or taking other medicines or supplements like calcium or iron.

Common dosing and missed doses

Alendronate often comes as a daily low-dose tablet or a larger weekly tablet. Your doctor will tell you which schedule to follow. If you miss a weekly dose, take it the morning after you remember unless the next weekly dose is due within two days—then skip the missed dose and resume the regular day. Never take two weekly tablets on the same day. For daily dosing, take the tablet the morning after you miss it, unless it is almost time for the next dose.

Side effects, warning signs, and when to call

Many people tolerate alendronate well. Common side effects include heartburn, stomach pain, nausea, and mild muscle or joint aches. More serious problems are rare but important: persistent chest pain, severe throat pain or trouble swallowing, new or worse heartburn, or severe jaw pain. Report any new hip or thigh pain quickly—this could be a sign of an unusual fracture in the thigh bone. Also tell your doctor about persistent tooth problems; long-term bisphosphonate use has been linked to rare jaw bone issues called osteonecrosis.

Before starting alendronate, let your clinician know if you have low blood calcium, kidney disease, difficulty swallowing, active peptic ulcers, or if you are pregnant or breastfeeding. Avoid taking antacids, calcium, iron, or some antibiotics within 30 minutes of your alendronate dose because they can stop it from absorbing. Your doctor will likely recommend calcium and vitamin D for bone health, but plan the timing so they don’t interfere with the tablet.

Most patients have a dental checkup before long-term treatment, especially if dental surgery is planned. Bone density scans (DEXA) and regular follow-up visits help your clinician decide how long to continue treatment—many people take alendronate for three to five years and then reassess the need for a break based on fracture risk. If you have questions about dosing, interactions, or side effects, ask your doctor or pharmacist. Small routine steps—taking the pill correctly, staying upright, and reporting new symptoms—go a long way toward safety and effectiveness.