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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Fosavance

Fosavance has been launched by MSD. This product contains Alendronate 70mg and colecalciferol 70micrograms in a once a week tablet. It will be priced at the same level as Fosamax, that is an NHS List price of £22.80 for 4 tablets.

It is licensed for the treatment of postmenopausal osteoporosis in patients at risk of vitamin D insufficiency. Further information is available in the Summary of Product Characteristics.

At present, Bisphosphonates (like Alendronate) are recommended for use in addition to a suitable Calcium and Vitamin D supplement. This product is being promoted based upon the fact that population data in the UK shows that the vast majority of people obtain sufficient calcium from their diet. The exception to this appears to be female patients who are aged over 65 and who live alone.

This product is an attempt at patent extension by the manufacturers of Fosamax as the patent is due to expire very soon. The place for this product remains unclear at present as supplementation with Calcium and Vitamin D supplements is the current empirical treatment.

Additionally, it may be difficult to assess the risk of Vitamin D insufficiency in order to comply with the product license. The skin produces Vitamin D naturally during exposure to sunlight.

Action: This product should not be used in preference to standard treatment (Calcium and Vitamin D supplement with or without a Bisphosphonate) until further data can demonstrate that Calcium supplementation is not required in patients who have already suffered an osteoporotic bone fracture, especially as patients with "postmenopausal osteoporosis" are likely to be female patients who are over 65 and living alone.

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56 Comments to “Fosavance”

  1. I am 52 years old and have been on fosovance for over 18 years and has recently told by my dr to stop taking the medication. I went through menopouse at a young age it started when I was 32. I still have my ovaries and is on hrt and estrogel my question to you should I be concerned that I have been on fosovance for too long and have I done more damaged then good. Regards Bev
    Canada

    Comment by Bev Keegan — January 27, 2014 #
    Reply

    1. @Bev,

      There is current debate about the optimal duration of treatment with medicines like Fosavance. I suspect your doctor has stopped it as he feels you have taken the therapy for a sufficient amount of time.

      Comment by Matthew Robinson — January 28, 2014 #
      Reply

  2. I have been taking calcium supplements and a monthly colecalciferol for my osteopenia for 8 years now. My last pelvic bone scan in April 2010 showed an improvement in the readings. I have been active in doing load bearing exercise.
    I recently moved to the Netherlands, and when my usual medication finished I consulted a doctor who didn't understand very much English. I am now post menopausal, so he prescribed Fosavance, and I decided before I got the prescription I would check it out - and here I am. I'm afraid to take this medication after reading about its side effects, and, of course, I wonder if it's necessary. Thank you for your advice.

    Comment by Alison Buchanan-Vaassen — December 2, 2012 #
    Reply

  3. I am 38 yrs old and have recently been prescribed fosavance for ostopenia (moderate ostopenia of the lower back). I have consumed three tablets so far. My concern is that every where I read I get to know that it is meant for post-menopausal women. Should I still take it? Or is consumption of calcium and vitamin D enough?

    Comment by Bani — July 29, 2012 #
    Reply

    1. @Bani,

      You need to speak to your doctor about this. In the UK, Fosavance is not recommended by the manufacturer for treating osteopenia, only post-menopausal osteoporosis. Alendronate, the main ingredient is recommended for men but again osteoporosis rather than osteopenia.

      Clearly, you have some concerns about the treatment and from the details you have given it seems that the manufacturers recommendations for use don't appear to apply to you, but your doctor will have more information and will be able to explain and hopefully reassure you.

      Comment by Matthew Robinson — July 29, 2012 #
      Reply

  4. I have been taking Fosavance for 8 months for osteopenia and had a DEXA scan yesterday only to find that there has been a slight deterioration of bone loss in my lumbar spine. My femur and wrist meaurements were normal.
    I am 61 years old and my mother had osteoporosis.
    I have side effects from this drug (aching bones and muscles) and would like to discontiue it completely. Is it really necassary to treat osteopenia with these types of drugs? I go to the gym twice a week and do weight bearing exercises and am in general good health and fit. Thanks for your advice.

    Comment by arlene khaireldin — May 16, 2012 #
    Reply

    1. @Arlene,

      Good question, and one to which we don't really know the answer. You might find this article in the New England Journal of Medicine makes good reading. Continued treatment with these drugs should certainly be reassessed periodically and consideration given to the pros and cons of carrying on with therapy.

      That discussion is best held with your doctor and should take into account your individual situation, family history, how long you've already been on the treatment and what level of impact the side effects are having.

      Comment by Matthew Robinson — May 16, 2012 #
      Reply

  5. Thank you SO much for a thorough and prompt reply. You confirmed what my online research suggests re: both the photosensitivity rash and, more importantly, whether I need to be taking this drug at all. I have booked an appt with my Dr for follow up. Thanks again, from Canada.

    Comment by Maureen MacDonald — August 25, 2011 #
    Reply

  6. @Maureen,

    The manufacturer (and UK regulatory authorities) are aware of some skin problems associated with this drug. 'Rash' and 'Rash with photosensitivity' are both listed in the known side effects and are Uncommon and Rare respectively.

    I guess it's possible that you may have missed that part of your ankle with the SPF50 and gotten the sun sensitive rash.

    That said, based on the information you have given above, your bone mineral density as you have reported indicates osteopenia, not osteoporosis. Also, your fracture was not a low trauma one if you broke it crashing a bicycle. So, I'd question whether you should be on treatment in the first place - certainly the current guidelines in use in the UK would not recommend that you were treated.

    I would suggest you return to your doctor and raise your concerns about treatment with them and perhaps ask what recommendations they are following that are suggesting you are treated.

    Comment by Matthew Robinson — August 25, 2011 #
    Reply

  7. Apologies, I should also mention I take liquid calcium/magnesium supplement and minimum 3,000 IU Vitamin D each day. I am a triathlete, so do regular weight bearing exercise.

    Comment by Maureen MacDonald — August 25, 2011 #
    Reply

  8. I have taken two doses of Fosovance. After the second one, I developed a 2 inch diameter red inflammation on my ankle. It's not itchy and after four days the redness is decreasing a bit but it's still there. I can think of nothing else that would cause this. I was out in the sun for several hours that day, but wearing 50 SPF sunscreen with frequent reapplication. Is this a possible Fosovance side effect? Has anyone experienced anything similar.

    For context, I am a very athletic, post-menopausal 54 year old. I broke my wrist after a bicycle crash in April 2011 and my bone density was -1.7 in Oct 2010 (decreased from the previous year) so my Dr. prescribed Fosovance. (I tried her initial prescription of didricol and was so sick I quit after three days). I have also had chest tightness for about three days after each tablet of Fosovance. I'm beginning to think the end doesn't nearly justify the means with this drug.

    Any comments on the rash would be welcome.

    Comment by Maureen MacDonald — August 25, 2011 #
    Reply

  9. Sorry, forgot to mention that recently I had a bone density index test & the result was -6.4

    Comment by Rajesh Misra — May 26, 2011 #
    Reply

  10. I am currently using Fosavance. How effective is it for me as I am a patient of Osteogenesis Imperfecta.

    Comment by Rajesh Misra — May 26, 2011 #
    Reply

    1. There have been studies that have examined use of oral alendronate in Osteogenesis Imperfecta (OI) although mainly in children. I assuming you are an adult.

      They have been shown to increase bone mineral density in children and adults and also reduce the rate of fragility fractures in children. You may find this article of interest.

      Comment by Matthew Robinson — May 26, 2011 #
      Reply

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