The suggestion by Bauer et al1 that there is no increased alendronate-related risk of upper gastrointestinal (GI) tract events "even in high-risk subgroups" must be questioned. The recent report by Graham and Malaty2 focused attention on the additional risk posed by concomitant use of alendronate with cyclooxygenase 1 (COX-1) nonsteroidal anti-inflammatory agents (NSAIDs), compounds with their own gastropathy risk. In addition to demonstrating a statistically significant gastric ulcer risk for alendronate therapy, Graham and Malaty2 documented quadrupled risk with concomitant NSAID ingestion. As these studies1,2 are disparate in their conclusions, it seems reasonable to examine the methods of the study by Bauer et al.1