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Bisphosphonate adverse effect — DGM MCQ

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ModerateFallsBisphosphonate adverse effectDGM

A 79-year-old woman develops severe retrosternal discomfort and dysphagia after starting osteoporosis treatment. She sometimes takes tablets in bed with little water. Endoscopy is being arranged. Current medicines include alendronic acid, calcium carbonate and ramipril. Which medication should be reviewed?

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

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Correct answer: B — Alendronic acid

Alendronic acid can cause oesophageal irritation, particularly if administration instructions are not followed. Calcium carbonate, ramipril, paracetamol and salbutamol are less likely to cause the described tablet oesophagitis pattern. Administration technique and gastrointestinal tolerance should be reviewed before continuing oral bisphosphonates.

Reference: BNF; NICE CG146