My wife's doctor says that because she suffers from GERD she is not a candidate for Fosamax for her osteoporosis. He says the reflux will probably contain the Fosamax, which will irritate her esophagus. Is this true?

T.C.

Alendronate (Fosamax) is a medication used for the treatment of osteoporosis. It is effective in reducing the risk of osteoporosis-related bone fractures. However, as your doctor mentioned, one of the main side effects of this drug is its propensity to irritate the upper gastrointestinal tract, especially the esophagus.

There have been reports of esophageal irritation, ulcers, bleeding and even scarring (strictures) in the esophagus as a result of using Fosamax. It is thought that this damage occurs because of the drug's effect on the lining of the esophagus. To help prevent Fosamax from remaining in the esophagus after it is swallowed, certain precautions are recommended. Patients should always take the medication with a glass of water and should not lie down after taking it. Fosamax should also be taken in the morning, not at night.

There are no specific guidelines for the use of Fosamax in patients with gastroesophageal reflux disease (GERD). In GERD, the stomach's acidic contents back up into the esophagus. So, theoretically, it is possible that after a Fosamax tablet has been broken down in the stomach, some of it could splash back into the esophagus and lead to irritation. GERD patients may also have weakened esophageal function due to acid-related irritation, which may possibly put Fosamax in contact with the esophageal lining for longer periods of time than in other people.

Your wife should discuss these issues with her doctor to decide on a treatment strategy for her osteoporosis. If she ends up taking Fosamax, she should follow up closely with her doctor to monitor its potential effects on her esophagus.