Patients w/ active upper GI problems (eg, dysphagia, oesophageal disease, gastritis, duodenitis, ulcers, or w/ recent history (w/in the previous yr) of major GI disease (eg, peptic ulcer, or active GI bleeding, or surgery of upper GIT other than pyloroplasty). May increase risk of oesophageal problems. Osteonecrosis of the jaw associated w/ tooth extraction &/or local infection (including osteomyelitis); consider dental exam w/ preventive dentistry prior to treatment & avoid invasive dental procedures if possible. Severe &/or incapacitating bone, joint, &/or muscle pain. Atypical subtrochanteric & diaphyseal femoral fractures; consider discontinuation of therapy in patient presenting w/ an atypical femur fracture; may present pain in the thigh or groin. Severe skin reactions (including SJS & TEN). Missed dose should be taken the morning after the patient remembers. Correct pre-existing hypocalcemia prior to initiating therapy. Monitor Ca & disorders affecting mineral metabolism (eg, vit D deficiency & hypoparathyroidism). Decreased serum Ca & phosphate may occur especially in patients taking glucocorticoids. May affect the ability to drive & use machine. Not recommended for patients w/ renal impairment (CrCl <35 mL/min). Not to be used during pregnancy & lactation.
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