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Bisphosphonate Administration — SCE Rheumatology MCQ

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EasyMetabolic Bone DiseaseBisphosphonate AdministrationSCE Rheumatology

A 60-year-old woman taking once-weekly oral alendronic acid for osteoporosis develops odynophagia. Upper gastrointestinal endoscopy shows oesophageal erosions. She reports taking each tablet with coffee and lying down immediately afterwards. Which administration instruction would most likely have reduced her risk of this complication?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Take it on rising with at least 200 mL of plain water and remain upright for at least 30 minutes

The correct answer is B. Alendronic acid should be swallowed whole on rising with at least 200 mL of plain water, at least 30 minutes before the first food, drink or other oral medicine. The patient must remain upright for at least 30 minutes. Lying down can prolong oesophageal contact and increases the risk of oesophagitis, erosions and ulceration. Coffee is also inappropriate because it markedly reduces alendronate absorption. Milk and food impair absorption, so A is incorrect. Coffee remains unsuitable in C despite the correct posture. Bedtime administration and only 10 minutes upright make D unsafe. The tablet must not be chewed because this may cause oropharyngeal ulceration, excluding E.

Reference: Viatris, Alendronic Acid 70 mg Tablets, Summary of Product Characteristics, sections 4.2 and 4.4, updated May 2026. https://www.medicines.org.uk/emc/product/100151/smpc