Which side effect is most commonly associated with alendronate use?

• A. Esophagitis
• B. Jaw necrosis
• C. Atypical fractures
• D. GI upset

Answer: (A)

Esophageal irritation from the medication is the most common issue with alendronate. Bisphosphonates can irritate the lining of the esophagus if the pill lingers there or isn’t swallowed with enough water, leading to esophagitis. That’s why the best approach to minimize risk is taking alendronate with a full glass of water and staying upright for at least 30 minutes after taking it. If symptoms like heartburn, odynophagia, or chest pain occur, it points to esophagitis rather than the rarer problems listed elsewhere. Jaw necrosis, atypical fractures, and general GI upset can occur too, but they’re less common or context-specific compared to esophageal irritation.