Senior Health Home > Precautions and Warnings With Alendronate and Cholecalciferol

Talk to your healthcare provider about the precautions and warnings with alendronate and cholecalciferol to help minimize risks. Before taking the drug, let your healthcare provider know if you have cancer, high or low blood calcium, or kidney disease. Precautions and warnings with alendronate and cholecalciferol also include being aware that the drug may cause osteonecrosis of the jaw, extreme muscle or bone pain, and high blood calcium.

Alendronate and Cholecalciferol: What Should I Tell My Healthcare Provider?

You should talk with your healthcare provider prior to taking alendronate and cholecalciferol (Fosamax Plus D™) if you have:
  • A narrowing of the esophagus (an esophageal stricture)
  • Difficulty swallowing
  • Low blood calcium (hypocalcemia) or high blood calcium (hypercalcemia)
  • Cancer
  • An inability to sit upright or stand for 30 minutes
  • Kidney disease, including kidney failure (renal failure)
  • Any allergies, including allergies to food, dyes, or preservatives.
Also, let your healthcare provider know if you are:
  • Pregnant or thinking of becoming pregnant
  • Breastfeeding
  • Planning to have a dental procedure.
Make sure to tell your healthcare provider about all medicines you are taking, including prescription and non-prescription medicines, vitamins, and herbal supplements.

Specific Precautions and Warnings With Alendronate and Cholecalciferol

Warnings and precautions to be aware of prior to taking alendronate and cholecalciferol include the following:
  • In rare cases, bisphosphonates (including alendronate and cholecalciferol) have caused a condition called osteonecrosis of the jaw. This is a serious, possibly disfiguring, problem in which the bone of the jaw dies. Often, there are symptoms (such as pain, infection, or loosening of the teeth), but sometimes there are no symptoms until a person notices exposed bone. This problem is most common when bisphosphonates are given by IV, but is still possible when these medications are taken orally. People who have dental procedures (such as a tooth extraction) seem to be at higher risk. Be sure to take good care of your mouth and teeth by seeing your dentist frequently. Let your healthcare provider know right away if you think you may have osteonecrosis of the jaw.


  • There have been rare reports of unusual broken thigh bones in people taking bisphosphonate medications like alendronate and cholecalciferol. It is not yet clear if the medications are to blame, since the fractures could simply be due to osteoporosis or other factors. These fractures typically were not caused by trauma or injury. Let your healthcare provider know if you have unexplained groin or thigh pain, as these are sometimes signs of thigh fractures. 


  • Alendronate and cholecalciferol, like all bisphosphonate medications, can irritate or damage the esophagus and stomach. This can lead to indigestion, heartburn, or even ulcers. Let your healthcare provider know if you notice any of these problems while taking the drug.
  • It is important to closely follow the instructions for taking alendronate and cholecalciferol. Not doing so could increase your risk of side effects or may make the drug ineffective (see Alendronate and Cholecalciferol Dosing).
  • It is important that you get enough calcium while taking the medication, either through your diet or by supplementation. Calcium is necessary for rebuilding bone and preventing further bone loss. Alendronate and cholecalciferol cannot work if you do not get enough calcium.
  • Vitamin D (one of the components of alendronate and cholecalciferol) can increase the level of calcium in your blood. Alendronate and cholecalciferol may not be the best choice for you if you already have high calcium in your blood. Since people with cancer frequently have high blood calcium, you may want to check with your healthcare provider before taking alendronate and cholecalciferol if you have cancer.
  • Alendronate and cholecalciferol may not be recommended for people with severe kidney disease.
  • Bisphosphonates (including alendronate and cholecalciferol) can cause extreme muscle or bone pain. This usually goes away once the medication is stopped.
  • Alendronate and cholecalciferol can potentially interact with a number of medications (see Drug Interactions With Alendronate and Cholecalciferol).
  • Alendronate and cholecalciferol is considered a pregnancy Category C medication. This means that it may not be safe for use during pregnancy (see Fosamax and Pregnancy).
  • It is not known whether alendronate and cholecalciferol passes through breast milk. Therefore, if you are breastfeeding or plan to start, discuss this with your healthcare provider prior to taking the drug (see Fosamax and Breastfeeding).
Written by/reviewed by:
Last reviewed by: Kristi Monson, PharmD;
Last updated/reviewed:
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