Alendronate tablets are taken with a glass of water in the morning, before breakfast. Experts recommend drinking some water with the drug. You aren't supposed to eat within 30 minutes of taking the drug. It is available only by prescription and should be taken only under a doctor's care. You should not take alendronate while pregnant.
A typical osteoporosis patient takes 10 mg/day or a single 70 mg/day pill once a week. 
Paget's disease patients take a much higher dose - 40 mg/day.
Binosto is a preparation of alendronate in effervescent tablets and is actually strawberry flavored. They sell it as a 70 mg tablet.
The pharmaceutical company Merck developed and first sold alendronate under the name Fosamax. The patent has expired and other companies can now sell alendronate, but they cannot call is Fosamax.
Pharmacies now sell generic alendronate for a low cost. Wal-Mart advertises one month’s supply at $9. Branded Fosamax from Merck still costs considerably more.
The World Health Organization lists alendronate as "essential medicine".
Alkaline phosphatase is an enzyme that can be used as a biomarker in alendronate treatment. Along with blood levels of calcium and phosphorus, it is periodically measured in patients who take bisphosphonates. Bone density is often measured to see if the drug is working as intended. Alendronate is not approved for pregnant women, and because the drug stays in the body for years, doctors are often reluctant to prescribe it for women who might get pregnant in the future.
Because of the drug's impact on the bone system, patients often are advised to take calcium and Vitamin D supplements.
It is commonly thought that osteoporosis develops purely from a reduction in bone mass (i.e., from bone loss). However, the condition can also result from never having obtained adequate bone mass during a the adolescent and young adult years. Therefore, the risk factors for osteoporosis begin early in life and include genetic, clinical, medical, behavioral, and dietary vulnerabilities. Additionally, risk factors that occur in combinations augment the chance of osteoporosis in an additive fashion. In other words, someone with two risk factors has a higher risk than someone with just one risk factor.
Although alendronate is generally safe even when taken for years at a time, it is common for patients and their doctors to agree on a drug holiday - a period when the regimen is halted. Drug holidays are common for other medicines, too, and alendronate seems especially well suited. Studies have shown the risk of fracture does not rise when a drug holiday is instituted after several years of taking alendronate. Alendronate stays in the body a very long time, and if it works as it should, the extra bone mass added typically does not disappear overnight when the medicine is halted.
Bisphosphonates block bone resorption. They have been widely used for years and although there can be side effects, the medical profession considers them generally safe and effective. More
Selective Estrogen Receptor Modulators (SERMs) are chemical compounds that act on the estrogen receptors in the body. More.
