Treat hypocalcemia & other disturbances of bone & mineral metabolism before starting therapy. Maintain adequate intake of Ca & vit D. Patients w/ active upper GI problems (eg, known Barrett's esophagus, dysphagia, other esophageal diseases, gastritis, duodenitis or ulcers). Greater risk of severe esophageal adverse experiences in patients who do not comply w/ the dosing instruction &/or those who continue treatment after developing symptoms suggestive of esophageal irritation. Discontinue use if patient develops dysphagia, odynophagia, retrosternal pain or new or worsening heartburn. Risk factors for osteonecrosis of the jaw (ONJ) including cancer diagnosis, concomitant therapies (eg, chemotherapy including angiogenesis inhibitors, RT, corticosteroids), & co-morbid disorders (eg, anemia, coagulopathy, infection, preexisting dental disease). Dental surgery may exacerbate condition for patients who develop ONJ while on therapy. Osteonecrosis of other oro-facial sites including the external auditory canal (possible in patients who present w/ ear symptoms including chronic ear infections). Atypical subtrochanteric & diaphyseal femoral fractures, primarily in patients receiving long-term treatment for osteoporosis. Consider discontinuation of therapy in patients suspected to have an atypical femur fracture. Galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption. Concomitant use w/ NSAIDs. Not recommended for patients w/ CrCl <30 mL/min. Not to be used during pregnancy. Lactation. Childn <18 yr.
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