alendronate and no progress

Posted by hillclan @hillclan, Jun 27, 2025

I have been taking alendronate (Fosamax generic) for 2 years. Just had another DEXA scan, and it showed slightly worse bone strength, by T score. My nurse practitioner thinks I should continue with the alendronate despite this. I have been diligent with calcium intake and vitamin D. Has anyone else had a similar experience?

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Profile picture for Michael Lavacot @michaellavacot

Hi @mel100 - Thnks for the complement but no, I am not a doctor, just a patient with way too much time on his hands 🙂

But you are in luck! All of us have been where you are, so I decided to put together a video presentation just for you and others like you. I am sure it will be very helpful and you will likely be able to teach your doctor a thing of two as well. And for the record, I do not get paid in anyway for the videos I put together, I'm just trying to give back to the community that helped me.

Feel free to ask questions after you watch it. Go here https://www.youtube.com/@michaellavacot and play "New to Osteoporosis? Start here!"

Mike

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Thank you for taking the time to do this. I find your research, charts, etc...very informative.

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@hillclan

This is very poor advice on the NP 's part. First of all your physician can order a test annually to verify progress. It just has to be written up properly. If the drug is not working and you've been diligently following manufacturers instructions time for a change of venue. Anabolics build quality bone.

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Profile picture for maggieb892 @maggieb892

My endocrinologist thinks so. At first I was drinking about 20 ounces of water when I took my fosamax and my results were not very good. After that she insisted that i drink only 8 ounces of water with my pill 6 months later I had the blood work repeated and had the results she expected. I guess sportiness more isn't better!

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Interesting. Not that I drink 20 ounces of water with any medication. Half a cup is enough for me. Glad you found the formula that works!

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Profile picture for kristie2 @kristie2

There are a lot of endo’s that don’t follow the bone markers. Personally I don’t understand that point of view. Yes, she should have done your CTX and P1NP. It would tell how much the osteoclast resorption is (CTX) and then the P1NP would show bone-formation marker of the osteoblastic activity. These markers are done prior to starting and then 3-4 months after to see if Evenity makes a difference for you. I would insist on having this done.

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Without the bone markers, you'd have no idea if the medication is working until you have the next DEXA scan. Doesn't make sense to me that a doctor wouldn't want them.

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Profile picture for njx58 @njx58

Interesting. Not that I drink 20 ounces of water with any medication. Half a cup is enough for me. Glad you found the formula that works!

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I live in Colorado where drinking a lot of fluids is very important. I start my day with good hydration

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Profile picture for rola @rola

@hillclan

This is very poor advice on the NP 's part. First of all your physician can order a test annually to verify progress. It just has to be written up properly. If the drug is not working and you've been diligently following manufacturers instructions time for a change of venue. Anabolics build quality bone.

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Thank you for sharing your thoughts. I'm going to try to see an endocrinologist again.

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Hello all. I want to give a bit of my medical background before commenting on Alendronate.
I have a primary diagnosis of hypermobile Ehlers Danlos Syndrome (hEDS) ; a connective tissue disorder that affects all body systems. (diagnosed in 2018....Google it if you are interested, and if any of my message here strikes a chord with you). I was diagnosed with Osteoarthritis in 2015, at age 55. After a total hysterectomy with bladder suspension and rectal repair in 2016, my hormones were all in disarray, until I could find a doctor who would honor my request for BioIdentical Hormone Replacement. There was a gap in time where I wasn't getting the Estrogen support needed, which could have contributed to my early (50's is early to me) Arthritis diagnosis. I also have been on Prozac (a Serotonin Reuptake Inhibitor), since post partum depression was diagnosed in 1994. I recently learned that longtime SSRI use can deplete bone density, so I DO wonder if this is part of my equation, as well. I moved from Osteopenia to Osteoporosis in 2021, from results of that years' DexaScan, and my PCP prescribed Alendronate/Fosamax to help stop the progression of bone density.

Two years into the treatment with Alendronate, I fractured 2 metarsal bones in my right foot, while "walking in the water" for exercise. The Podiatrist told me that obviously, Alendronate was not doing the job for me, and we both agreed that loose ligaments or muscles (hEDS) was probably part of the issue as well. He ordered Physical Therapy for me, to help strengthen my foot and toe muscles. I also went to my PCP and told her I was feeling extremely fragile, and wanted to seek further treatment advice. I was referred to a local Endocrinologist, who ordered labs for Thyroid function among other tests. He recommended TYMLOS (an Anabolic) stating that Tymlos has had great results in building new bone strength. I am completing my 12th month of treatment, and will see my Endo next week. He will compare my recent Dexa-Scan with the one from 2024, and determine how much longer I need to take it.
I will post back what I learn at the appointment. I don't know for sure why the Alendronate didn't help me...but I obviously have other issues at play...weak ligaments in my feet, ankles, etc. I continue to do Physical Therapy exercises for my toes, my ankles, PT also for balance and strengthening of upper and lower body muscles around my joints, for my neck and for Temporamandibular dysfunction. I have also done Occupational Therapy for my shoulders and hands (Carpal MetaCarpal bones and my thumbs), when pain or limited functioning are holding me back. I cannot say enough good about Physical and Occupational Therapy. There is so much that can be done with exercises and stretching. It is my 1st "go to" over asking for pain medications, when one of my body parts decides to give me problems. I am also a member of the Ehlers Danlos support group on this platform, and would urge anyone reading this, who finds any similarities in your situation, to google EDS and/or check out the other support group. I was 57 years old when I started connecting the many dots in my health journey, and received a firm diagnosis of hEDS. I have had it and symptoms since I was born.

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Profile picture for hipmama @hipmama

Hello all. I want to give a bit of my medical background before commenting on Alendronate.
I have a primary diagnosis of hypermobile Ehlers Danlos Syndrome (hEDS) ; a connective tissue disorder that affects all body systems. (diagnosed in 2018....Google it if you are interested, and if any of my message here strikes a chord with you). I was diagnosed with Osteoarthritis in 2015, at age 55. After a total hysterectomy with bladder suspension and rectal repair in 2016, my hormones were all in disarray, until I could find a doctor who would honor my request for BioIdentical Hormone Replacement. There was a gap in time where I wasn't getting the Estrogen support needed, which could have contributed to my early (50's is early to me) Arthritis diagnosis. I also have been on Prozac (a Serotonin Reuptake Inhibitor), since post partum depression was diagnosed in 1994. I recently learned that longtime SSRI use can deplete bone density, so I DO wonder if this is part of my equation, as well. I moved from Osteopenia to Osteoporosis in 2021, from results of that years' DexaScan, and my PCP prescribed Alendronate/Fosamax to help stop the progression of bone density.

Two years into the treatment with Alendronate, I fractured 2 metarsal bones in my right foot, while "walking in the water" for exercise. The Podiatrist told me that obviously, Alendronate was not doing the job for me, and we both agreed that loose ligaments or muscles (hEDS) was probably part of the issue as well. He ordered Physical Therapy for me, to help strengthen my foot and toe muscles. I also went to my PCP and told her I was feeling extremely fragile, and wanted to seek further treatment advice. I was referred to a local Endocrinologist, who ordered labs for Thyroid function among other tests. He recommended TYMLOS (an Anabolic) stating that Tymlos has had great results in building new bone strength. I am completing my 12th month of treatment, and will see my Endo next week. He will compare my recent Dexa-Scan with the one from 2024, and determine how much longer I need to take it.
I will post back what I learn at the appointment. I don't know for sure why the Alendronate didn't help me...but I obviously have other issues at play...weak ligaments in my feet, ankles, etc. I continue to do Physical Therapy exercises for my toes, my ankles, PT also for balance and strengthening of upper and lower body muscles around my joints, for my neck and for Temporamandibular dysfunction. I have also done Occupational Therapy for my shoulders and hands (Carpal MetaCarpal bones and my thumbs), when pain or limited functioning are holding me back. I cannot say enough good about Physical and Occupational Therapy. There is so much that can be done with exercises and stretching. It is my 1st "go to" over asking for pain medications, when one of my body parts decides to give me problems. I am also a member of the Ehlers Danlos support group on this platform, and would urge anyone reading this, who finds any similarities in your situation, to google EDS and/or check out the other support group. I was 57 years old when I started connecting the many dots in my health journey, and received a firm diagnosis of hEDS. I have had it and symptoms since I was born.

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I'm sorry about your difficulties with EDS. It sounds like you have been through a lot to find good treatment. I appreciate you sharing your experience and stating that PT and OT have helped you out quite a bit. I'm inspired by your efforts.

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Profile picture for hipmama @hipmama

Hello all. I want to give a bit of my medical background before commenting on Alendronate.
I have a primary diagnosis of hypermobile Ehlers Danlos Syndrome (hEDS) ; a connective tissue disorder that affects all body systems. (diagnosed in 2018....Google it if you are interested, and if any of my message here strikes a chord with you). I was diagnosed with Osteoarthritis in 2015, at age 55. After a total hysterectomy with bladder suspension and rectal repair in 2016, my hormones were all in disarray, until I could find a doctor who would honor my request for BioIdentical Hormone Replacement. There was a gap in time where I wasn't getting the Estrogen support needed, which could have contributed to my early (50's is early to me) Arthritis diagnosis. I also have been on Prozac (a Serotonin Reuptake Inhibitor), since post partum depression was diagnosed in 1994. I recently learned that longtime SSRI use can deplete bone density, so I DO wonder if this is part of my equation, as well. I moved from Osteopenia to Osteoporosis in 2021, from results of that years' DexaScan, and my PCP prescribed Alendronate/Fosamax to help stop the progression of bone density.

Two years into the treatment with Alendronate, I fractured 2 metarsal bones in my right foot, while "walking in the water" for exercise. The Podiatrist told me that obviously, Alendronate was not doing the job for me, and we both agreed that loose ligaments or muscles (hEDS) was probably part of the issue as well. He ordered Physical Therapy for me, to help strengthen my foot and toe muscles. I also went to my PCP and told her I was feeling extremely fragile, and wanted to seek further treatment advice. I was referred to a local Endocrinologist, who ordered labs for Thyroid function among other tests. He recommended TYMLOS (an Anabolic) stating that Tymlos has had great results in building new bone strength. I am completing my 12th month of treatment, and will see my Endo next week. He will compare my recent Dexa-Scan with the one from 2024, and determine how much longer I need to take it.
I will post back what I learn at the appointment. I don't know for sure why the Alendronate didn't help me...but I obviously have other issues at play...weak ligaments in my feet, ankles, etc. I continue to do Physical Therapy exercises for my toes, my ankles, PT also for balance and strengthening of upper and lower body muscles around my joints, for my neck and for Temporamandibular dysfunction. I have also done Occupational Therapy for my shoulders and hands (Carpal MetaCarpal bones and my thumbs), when pain or limited functioning are holding me back. I cannot say enough good about Physical and Occupational Therapy. There is so much that can be done with exercises and stretching. It is my 1st "go to" over asking for pain medications, when one of my body parts decides to give me problems. I am also a member of the Ehlers Danlos support group on this platform, and would urge anyone reading this, who finds any similarities in your situation, to google EDS and/or check out the other support group. I was 57 years old when I started connecting the many dots in my health journey, and received a firm diagnosis of hEDS. I have had it and symptoms since I was born.

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Thanks for sharing your stories.

May I ask - while you were on Fosamax, were you also taking HRT at the same time? And now, are you taking HRT along with Tymlos?

Tymlos is a great osteoanabolic agent - wishing you the best of success with the therapy! Please keep us updated.

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I take the same medication, I have been taking it for 2 years also. I have already lost 1 and 3/4 inches in height, so I take it and recommend calcium and vitamin d . But I am constantly in pain. All the procedures tried did not work and were almost as painful as osteoporosis. I do recommend following the doctors instructions because they do care. Good luck.

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