Major adverse effects with the oral preparations
include gastrointestinal upset including reflux and
potential esophagitis and, hence, should not be used
in patients with esophageal dysfunction or severe
reflux. IV preparations circumvent this issue. Because
the oral preparations are so poorly absorbed, they
must be taken on an empty stomach, with no eating
for at least 30 minutes after ingestion. Dosing is once
monthly for ibandronate and risedronate and once
weekly for most preparations of alendronate. The IV
preparations are given once yearly in the case of
zoledronate and every 3 months for ibandronate.