Osteoporosis

Fosamax and Alzheimer's

08/15/1999

Question:

My 87 year old grandmother, diagnosed with Alzheimers disease (moderate progession), has been taking Fosamax for the last 2 years. She has, over the past several weeks, developed chest pain; heart problems were ruled out. I suspect the pain may be attributable to esophageal irritation induced by the Fosamax; given her mental condition, I question whether she is capable of following the instructions for properly taking Fosamax (i.e. not reclining for at least 30 min and drinking a full glass of water). Her doctor prescribed a proton pump inhibitor and from what I understand has not instructed her to stop taking the Fosamax; in addition, he has not performed any tests to ascertain if she does indeed have esophageal erosion. Is this appropriate? My gut feeling is that she is no longer a good candidate for Fosamax and that perhaps Miacalcin nasal spray might be a better choice for her, if she could be trained to use it. Do you agree?

Answer:

There are different ways to approach this problem. It certainly is of utmost importance that your grandmother be capable of taking the medication correctly for two reasons 1) irritation of the esophagus if she does not remain upright, and 2) if she eats or drinks before 30 minutes, the medication will not be absorbed and will be of no benefit to her whatsoever. I would recommend that you ascertain whether she can take the medication correctly and then express your concerns to her physician. One option when anyone is having possible side effects from a medication is to stop the medication and see if the symptoms go away.

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Response by:

Margery Gass, MD
Professor, Clinical Obstetrics & Gynecology
Department of Obstetrics & Gynecology
College of Medicine
University of Cincinnati