Fosomax, in the class of medications called bisphosphonates, is a medication that has been shown to slow the bone resorption process. Originally introduced as a multi-purpose medication to slow bone thinning [1], the FDA now only classifies Fosamax as an approved for “treatment of osteoporosis (bone thinning) in women after menopause”, “treatment to increase bone mass in men with osteoporosis”, and as a “treatment of Paget's disease of bone in men and women”. [2]

 

Avascular Necrosis of load-bearing joints is a balancing act between the body's processes of breaking down the dead bone and healing to replace the broken-down bone. The primary problem with AVN in load-bearing joints is that the bone tends to break down faster than the body can heal and regenerate new bone, thus resulting in bone collapse. Over the years, Fosamax has commonly been prescribed to Avascular Necrosis patients because doctors assumed that Fosamax would help slow bone resorption (bone loss) of the necrotic (dead) bone and thus give the body's natural healing process a better chance. Unfortunately, this assumption that Fosamax might help improve chances of naturally healing necrotic bone has been proven incorrect. While Fosamax can help slow bone resorption, a side-effect of the medication is that it actually inhibits the bone turnover required to heal necrotic bone. In fact, the revised and current product information sheet for Fosamax, which is available from the FDA, states, “alendronate treatments reduces bone turnover (i.e.,the number of sites at which bone is remodeled)”. [3]  Slowed bone turnover may equate to slowed bone growth and healing. [7]

 

In summary, as a treatment for Avascular Necrosis, Fosamax: