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Case Reports and Small Case Series
June 1999

Ocular Inflammation Associated With Alendronate Therapy

Arch Ophthalmol. 1999;117(6):837-838. doi:

Bisphosphonates are potent inhibitors of osteoclast-mediated normal and abnormal bone resorption. Increasingly, they are being used for the management of Paget disease, hypercalcemia associated with malignant neoplasms, painful bone metastases, and osteoporosis. The first approved bisphosphonates, pamidronate and residronate, have been associated with ocular inflammation including iritis, nonspecific conjunctivitis, episcleritis, and scleritis.1,2 Reintroduction of the offending drug, in some of these cases, led to recurrence of ocular inflammation.2,3

A member of this group, alendronate sodium (Fosamax; Merck & Co Inc, Whitehouse Station, NJ) is 100 to 500 times more potent than initial amino-bisphosphonates4 and is being used successfully to prevent and treat osteoporosis in postmenopausal women. It induces progressive increases in bone mineral density, thereby reducing the incidence of osteoporosis-related pathologic fractures.5,6 Adverse effects include upper gastrointestinal tract complaints such as dyspepsia, heartburn, vomiting, dysphagia, esophageal reflux, and esophageal ulceration and strictures.7 To our knowledge, alendronate has not been previously associated with any kind of ocular inflammation. We report 3 cases of alendronate-associated posterior scleritis and anterior nodular scleritis with possible contiguous orbital inflammation and myositis that resolved after anti-inflammatory therapy and discontinuation of alendronate.