Discontinue use if dysphagia, odynophagia, retrosternal pain, new or worsening heartburn develops. Local irritation of upper GI mucosa; active upper GI problems eg, dysphagia, esophageal diseases, gastritis, duodenitis or ulcers. Osteonecrosis of the jaw (ONJ) & external auditory canal; bone, joint &/or muscle pain; low-energy subtrochanteric & proximal femoral shaft fractures. Evaluate stress fractures, known causes & risk factors eg, vit D deficiency, malabsorption, glucocorticoid use, previous stress fracture, low extremity arthritis or fracture, extreme or increased exercise, DM, chronic alcohol abuse. Poor oral hygiene, co-morbid disorders (eg, periodontal &/or other pre-existing dental disease, anemia, coagulopathy, infection), smoking. Hypoparathyroidism, Ca malabsorption. Invasive dental surgery eg, tooth extraction, dental implants. Correct hypocalcemia & other disorders affecting mineral absorption prior to therapy. Monitor serum Ca, phosphate & urine. Concomitant use w/ chemo- & RT, corticosteroids, angiogenesis inhibitors, bisphosphonates. Not recommended in severe renal insufficiency (CrCl <35 mL/min). Not to be used during pregnancy & lactation. Not to be given to childn.
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