Can alendronate (bisphosphonate) cause stomatitis?

Alendronate and Stomatitis

Alendronate can cause stomatitis and oral mucosa ulcerations as an adverse effect, though it is not among the most commonly reported side effects. 1, 2

Evidence on Alendronate and Oral Mucosal Effects

Documented Oral Side Effects

• Case reports have documented extensive palatal ulcers and ulcerative stomatitis directly attributed to alendronate use 1
• A case report described a 90-year-old woman who developed extensive bullous and ulcerative lesions on the tongue, oral vestibule, and buccal mucosa while taking alendronate (Fosamax) for osteoporosis 2
  • Complete recovery of the oral mucosa was observed three months after discontinuing alendronate

Mechanism of Oral Mucosal Irritation

• The oral mucosal reactions may occur through:
  1. Direct irritant mechanism similar to what causes esophageal irritation 1
  2. Possible T-cell mediated delayed hypersensitivity to the drug 3

Common Side Effects of Alendronate

According to clinical guidelines, the most frequently reported side effects of alendronate are:

• Upper GI irritation (more commonly reported than stomatitis)
• Myalgias and arthralgias 4

The American Society of Clinical Oncology guidelines note that upper GI irritation is among the common side effects of alendronate, though they don't specifically mention stomatitis 4.

Clinical Considerations

Risk Factors for Oral Mucosal Reactions

• Poor adherence to administration instructions
• Possible individual hypersensitivity to the medication 3

Proper Administration to Minimize Risk

• Take on an empty stomach with a full glass of water
• Remain upright for at least 30 minutes after taking
• Avoid consuming food or other medications during this time 5

Management of Alendronate-Related Stomatitis

If stomatitis develops while on alendronate:

1. Consider temporary discontinuation of the medication
2. Consult with the prescribing physician about alternative osteoporosis treatments
3. Monitor for resolution of symptoms (typically occurs within weeks to months after discontinuation) 2

Prevention of Oral Complications

• Maintain good oral hygiene
• Undergo comprehensive dental examination prior to starting therapy
• Follow proper administration instructions to minimize risk of mucosal contact with the medication 5

While stomatitis is not among the most commonly reported side effects of alendronate in large clinical trials 6, case reports clearly document its occurrence 1, 2. Healthcare providers should be aware of this potential adverse effect when prescribing alendronate and educate patients about proper administration techniques to minimize risk.