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Osteoporosis: oral ulceration caused by bisphosphonates

Bisphosphonates cause painful oral ulcerations when the tablets are sucked or chewed. This adverse effect is avoidable if certain precautions are taken.

There are several bisphosphonates on the market, particularly as a treatment for osteoporosis: alendronic acid, etidronic acid, ibandronic acid and risedronic acid. Bisphosphonates, known to cause oesophageal irritation and even ulceration, require strict precautions to be taken: swallow the tablets without sucking them, with a large glass of tap water or lightly mineralised water, in a sitting or standing position, on an empty stomach upon awakening, then wait at least 30 minutes before eating any food or drinking anything.

Several instances of oral ulceration have been linked to direct contact between the tablet and the oral mucous membrane. This applies to all bisphosphonate-based drugs, even if it is not always mentioned in the precautions for use.

Patients must be given strict directions as to the precautions to be taken when taking bisphosphonate tablets, in particular not chewing the tablets or allowing them to melt in the mouth, in addition to the precautions to prevent oesophageal ulceration (large glass of water, empty stomach, etc.).

©Prescrire May 2007

Source: "Ulcérations buccales dues aux diphosphonates" Rev Prescrire 2007 ; 27 (283) : 358.

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