Alendronate oesophagitis

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Editor, – The article about alendronate oesophagitis (Aust Adverse Drug Reactions Bull 1997;16:10) provides a timely reminder about the significant problems that can arise in older patients with medications that would be tolerated in younger, more physiologically intact and well individuals. Swallowing dysfunction is a common finding in older patients, but is often subclinical and unrecognised until major problems with nutrition, aspiration or reflux occur.

A drug such as alendronate may precipitate significant adverse effects in susceptible elderly individuals. The worrying thing is that these elderly patients frequently will not present with specific symptoms and signs, but rather a cycle of illness and failing function, with the underlying reason easily missed. The increasing recognition of osteoporosis and the widespread use of bone densitometry will place pressure on doctors to treat osteoporosis with these drugs. We may see a consequent increase in adverse events in susceptible patients.

Tuly Rosenfeld
Prince of Wales Hospital
Randwick, N.S.W.