Swallowing difficulties concern a man prescribed Fosamax

Dear Dr. Roach: Iama 71-year-old man who recently had a bone density scan. The test showed I had mild bone loss, and I was told I needed to go on medication. I was prescribed a vitamin D and calcium supplement as well as 70 mg of Fosamax to be taken once a week.

I am OK with the vitamin supplements, but I am nervous about taking Fosamax. After reading the instructions given by the pharmacy for this medication, I noticed that one of the possible side effects is difficulty swallowing. The only other medication I am taking now is a once-daily dose of 20 mg of Lipitor. I was previously taking a baby aspirin tablet with it. The problem is that I developed swallowing difficulties from taking the aspirin.

After taking a blood test, my primary care doctor said my cholesterol number had come down to a point where it would be safe to discontinue the aspirin, but stay on the Lipitor. After stopping the aspirin, the swallowing problem disappeared as well as the purple splotches on my hands and arms. I am concerned that I may once again develop swallowing problems if

I start taking Fosamax. After reading the ingredient label, this medicine contains some heavy-duty chemicals that are a lot more potent than simple baby aspirin.

Do you think it is wise for me to begin taking this medication, or should I contact the bone clinic and discuss other options? It is a very uncomfortable feeling when you are not able to swallow properly, and I do not want to experience this again like I did with the aspirin. Do people using this medication experience difficulty swallowing commonly? Is this drug completely safe? — Anon.

Dear Anon.: I need to correct some information here. First, alendronate (Fosamax) does not cause swallowing problems, but it can be dangerous to take the medication if you can’t swallow properly, since the pill can cause terrible inflammation in the esophagus if it gets stuck there. That’s why we give very stringent advice about taking it with a full glass of water, and to remain upright after taking it.

Further, this medication should be avoided in people with swallowing difficulties. I’m not sure what swallowing problem you may have had. I think it deserves more investigation before deciding whether this medicine is safe for you, from the standpoint of swallowing. Aspirin use is associated with an increased risk of a stricture, a partial mechanical blockage of the esophagus, which may explain the symptoms you had while on aspirin. There are other options available, including a similar medicine that can be given via IV once a year.

The second issue is the very frequent concern I often hear about osteoporosis medicines being “heavy duty” and “potent.” It is true that they can cause problems when used unskillfully (especially when given for too many years or in people who don’t really need it), but they also can prevent a devastating complication of a hip fracture when used correctly.

The results of the bone density (especially the T-score of the hip and spine) should be combined with other clinical information to calculate the FRAX score, which gives an estimate of an individual’s fracture risk. This is the most important information you need to help you decide whether you need this medicine. No medicine — whether it’s prescribed, over-the-counter or a supplement — is ever “completely safe.”

Finally, men in their 70s can certainly get osteoporosis, but I recommend a check of the testosterone level in every man who is diagnosed with osteoporosis.