Which class of medication is used to treat osteoporosis and may cause esophageal irritation if not swallowed with water?

• A. Selective estrogen receptor modulators
• B. Calcitonin
• C. Bisphosphonates
• D. PTH analogs

Answer: (C)

Bisphosphonates are used to treat osteoporosis by binding to bone and inhibiting osteoclast-mediated bone resorption, which helps preserve bone density. A crucial practical point is that these medications can irritate the esophagus if the pill lingers there, so they must be swallowed with a full glass of water and the patient should stay upright for at least 30 minutes after taking them to minimize contact with the esophageal lining. If the esophagus is irritated or if the patient doesn’t take them correctly, esophagitis or esophageal ulcers can occur. IV forms exist and avoid this esophageal issue, though they have their own considerations.

Other osteoporosis therapies—such as selective estrogen receptor modulators, calcitonin, or parathyroid hormone analogs—work differently and don’t carry the same esophageal irritation risk tied to oral administration.