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Updated: Dec 11 2017


  • Snapshot
    • A 65-year-old woman presents to her primary care physician’s office for evaluation of heartburn. She had her last menstrual period 15 years ago and was diagnosed with osteoporosis a year ago. She started taking alendronate 1 month ago for the osteoporosis. She admits to drinking minimal water and lying down shortly after taking her medications to watch TV or sleep. She has had heartburn for the past 3 weeks, with occasional pain on swallowing. She also reports having abdominal pain 1-2 times per week post-meals. She is counselled on the importance of eating her alendronate with lots of water and staying upright at least 30 minutes after taking the pill.
  • Introduction
    • Mechanism of action
      • analogs of pyrophosphate, which bind hydroxyapatite in bone and inhibits osteoclast activity
    • Clinical use
      • osteoporosis
      • hypercalcemia
      • Paget disease of bone
      • osteogenesis imperfect
      • metastatic bone disease
    • Toxicity
      • esophagitis
        • to prevent this complication, patients must take with lots of water and remain upright for 30 minutes
        • presentation includes heartburn, retrosternal pain, pain with swallowing, abdominal pain, and occasional hematemesis
      • osteonecrosis of the jaw
      • atypical stress fractures
      • gastrointestinal upset
    • Medications
      • alendronate
      • ibandronate
      • risedronate
        • minimal gastrointestinal toxicity
      • zoledronate
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