Which adverse effect is commonly associated with oral bisphosphonates?

• A. Esophageal irritation
• B. Hypertension
• C. Hepatotoxicity
• D. Hypercalcemia

Answer: (A)

Oral bisphosphonates commonly irritate the lining of the esophagus. They travel through the esophagus to reach the stomach, and when taken with insufficient water or if the person lies down soon after dosing, the medication can contact and irritate the esophageal mucosa. This can lead to dysphagia, retrosternal pain, or esophagitis, and in some cases ulcers. Because of this local GI irritation risk, the standard counseling is to take the medication with a full glass of water and remain upright for at least about 30 minutes after dosing. The other options—hypertension, hepatotoxicity, and hypercalcemia—do not represent the typical adverse effects of oral bisphosphonates.