Alendronate swallowing difficulty — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsAlendronate swallowing difficultyGPhC CRA

An 83-year-old with osteoporosis has dysphagia and cannot reliably remain upright after swallowing. A new prescription for alendronic acid tablets is presented. What should the pharmacist do?

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Correct answer: A — Withhold tablets and assess an injectable option after full screening

Withhold tablets and assess an injectable option after full screening: Dysphagia and inability to remain upright create unacceptable oesophageal risk; parenteral options require their own renal, mineral, dental and continuation planning. Use soluble alendronate while the patient remains recumbent: A soluble formulation does not remove the post-dose upright requirement or aspiration and oesophageal concerns. Change to weekly risedronate with the same swallowing routine: Another oral bisphosphonate retains important swallowing and upright-posture precautions. Give intravenous zoledronate after checking calcium and dental status: Zoledronate requires renal and other suitability checks rather than direct unscreened substitution. Start denosumab after checking eGFR and current calcium status: Denosumab needs calcium and vitamin-D assessment and a safe long-term discontinuation plan.

Reference: BNF: alendronic acid: https://bnf.nice.org.uk/drugs/alendronic-acid/; NOGG clinical guideline for osteoporosis: https://www.nogg.org.uk/full-guideline