Alendronic Acid and bottled/mineral water.

[Positive__]

Hi everyone,

This morning I suddenly had a thought about the Alendronic Acid tablet which states it must not be taken with mineral or bottled water!

I'm interested to hear from anyone that was taking it when they travelled? DorsetLady , please can I ask were you taking AA when you went to New Zeland? Please can I ask what did you do?

The Royal Osteoporosis Society says not to worry if you have to use bottled/mineral water for a short time and to just choose the one with lowest calcium (link below). So I guess I need not worry. I presume the tap water will be safe in Australia but we'll definitely be drinking bottled water in Malaysia and Mauritius (but only one AA dose in each).

I don't really understand the difference between mineral, spring and treated bottled water. We've been in some countries in the past where "drinking water" had been sold which had been treated.

Also I think non tap water just makes AA slightly less absorbed so not the end of the world and better to be taking it under those circumstances than not.

theros.org.uk/blog/10-top-t....

[DorsetLady PMRGCAuk volunteer]

Was taking it first time I went, but it didn’t fall on a day when I was either flying or in Singapore -so not an issue.

As it will only affect 2 doses, maybe give them a miss - or as you suggest.

If Oz is an issue -although doubt it -you could take with cooled boiled tap water.. I had to when the water tank got some bugs in it! (not on mains in rural NZ)

[Positive__ in reply to DorsetLady]

Thank you. I think I'll just choose lowest calcium bottled water on offer for the Malaysia and Mauritius doses. We're not going anywhere too rural in Oz, plus 2 of the 4 Oz doses will be when we're staying with rellies so will be tap water then.

I do feel more relaxed with it now.

Many thanks. 🌸

[DorsetLady PMRGCAuk volunteer in reply to Positive__]

👍

[PMRpro Ambassador]

It isn't just mineral waters - well water was what made them look more closely!!! However, just saying "mineral water" is a bit silly as they all differ and some bottled waters are actually pretty low in calcium as I'll show lower down.

I have looked this up in detail once before and it is high mineral content in the water that is the problem when used consistently - like people dependent on a non-mains source of water. The odd single dose is unlikely to be a problem and here in Europe the calcium content is listed - find the lowest you can.

southernscientificireland.c...

shows how much less Volvic has compared with others for example.

This study

ncbi.nlm.nih.gov/pmc/articl...

is quite interesting, saying

"It is noteworthy that the calcium content of sparkling or carbonated waters sold in Switzerland, varied enormously. Here, the calcium content varied from 8.4 mg/l (San Clemente Frizzante) to 581.6 mg/l (Meltinger). Of all water brands included in our study, sparkling water from Meltinger contained the highest calcium content. In fact, 75% of the water with a calcium content exceeding 400 mg/l originated from Switzerland. These included Adelbodner Mineral (579.0 mg/l), Farmer Mineral Rot (564.0 mg/l), Adello Mineral (530.0 mg/l), Eptinger Pricklnd (510.0 mg/l) and Valser (435.0 mg/l). Carolinen Classic and Carolinen Medium, which are sold in Germany contained 421.0 mg/l of calcium. The lowest calcium concentration of all the waters included in our study was 2.9 mg/l from Sant’ Anna, Italy. This means that the overall calcium content across Europe could be 200 times as high in one country compared to another."

So don't worry for the odd dose - and go into a supermarket and look for low calcium bottled water. If the local water is dodgy, then they will sell "ordinary" water for everyday use that is not mineral water - far too expensive.

[Positive__ in reply to PMRpro]

Thank You PMRPro, it is all very interesting isn't it. Thank you for the links to the studies.

I am reassured. Yes we usually always did choose "drinking water" rather than mineral water because it's cheaper.

I guess we are really lucky that we can just drink tap water here. Although I live in Swindon, Wiltshire which has very hard water. Apparently my water has 349 Mg/l CaCo3. Though I don't know if this is the same unit as the Calcium mentioned in the studies or because its Calcium Carbonate that makes a difference? I know you are very scientific so would be very interested to hear your thoughts. Here's where I found that value: scaleguard.co.uk/hard-water...

That would be quite ironic if my normal tap water has a high amount of calcium and I'm worrying about a few doses in a foreign country. 🤣

[DorsetLady PMRGCAuk volunteer in reply to Positive__]

I live in hard water area -and have for virtually all my life (apart from a few years in other parts of UK and Germany) - Doesn’t do a lot for appliances or wallet -but I seem to be okay on it! 😊

[PMRpro Ambassador in reply to Positive__]

Yes - that is such a valid point isn't it!!! I wonder if someone simply didn't understand the term and use of bottled waters. I'm pretty sure that it is calcium carbonate they measure and yes, the units are the same.

You can drink tap water pretty much all over Europe these days - and here we often drink water straight off the mountain from springs/drinking fountains which are all over the place. But tourists still buy plastic bottles of water with all the dubious levels of plastics in them!

PS - wonder what the ROS helpline would make of it!

[Oh-my in reply to Positive__]

My GP gave me calcium diet sheet for getting good sources of calcium (as an alternative to supplements). Tap water is included as a good source and like you I live in a very hard water area. No idea if it is having a detrimental effect when I take alendronic acid but there must be plenty of people in the same situation.

[PMRpro Ambassador in reply to Oh-my]

Well exactly - some clarity is called for I think!!

[Paulagcl]

Interesting. I used to take it (now I get the Prolia injections twice a year) and I never heard that I should watch calcium in water. I sometimes filter my water but othertimes use the tap. I've read that many bottled waters just bottle up local water and that we don't always know what we are getting. An hour after the pill then I would have breakfast and calcium in that, plus I was told to take a calcium supplement because of being on prednisone, which leaches calcium from the bones.

[Positive__ in reply to Paulagcl]

Hi Paulagcl, I too have been prescribed Adcal-D3 twice a day which is Calcium and Vit D. However I was told not to take it on the one day of the week I take the Alendronic Acid. I'm always surprised how very patchy and inconsistent the Doctor's advice (and indeed medication) is, given we all have the same condition. I have of course increased the calcium in my diet including having yoghurt/kefir each morning for breakfast, so as you say after the half hour wait after taking the Alendronic Acid, I having a burst of calcium.

[DorsetLady PMRGCAuk volunteer in reply to Positive__]

Although you shouldn’t take Adcal at same time as AA (as calcium can affect it’s absorption) there is no reason to omit it altogether that day. Take morning dose 3-4 hours later, and evening dose as usual.

So maybe think about your “burst of calcium” after 30 mins.

[Oh-my in reply to DorsetLady]

Is yogurt and milk after 30mins of taking AA a bad idea? I have doing this as I take my pred then. I thought if the calcium is food based it would be a slower absorption rate too and the leaflet says just wait 30mins. I will change it if it's advisable.

[DorsetLady PMRGCAuk volunteer in reply to Oh-my]

Probably okay... think advice is more likely to be for supplements or ultra rich calcium foods..sure milk/yogurt okay. I did similar for 4 years no issues. But always worth looking at ROS site if unsure -or to put your mind at rest -

theros.org.uk/information-a...

[AgedCrone]

TBH I often missed taking my weekly AA….not intentionally, but I’d forget it. …my Doc was not bothered.

Yes tap water is safe in Australia…in homes & hotels, but I’d be doubtful about anywhere out in the country……but I wouldn’t be too bothered about Singapore…..the hotels there are very sophisticated …..if you ask at reception they will answer your queries.

Just fly off & enjoy your trip..a couple of missed AA tablets is not the end of the world.

,

[Paulagcl]

It's frustrating how much conflicting info we get even from nutritionists. It used to be said that older people need to eat less protein because it can be hard on the kidneys otherwise. Now they are seeing we need more than ever!!

[pink123floyd]

Hi I always used bottled spring water as our tap water is undrinkable its very hard and gross never had a problem with taking it with A.A

[PMRpro Ambassador in reply to pink123floyd]

You wouldn't - it is whether you absorb the AA as well with the various waters.