Chronic Oral Alendronate Use is Associated with Gastrointestinal Reflux Disease and Voice Alterations Irrespective of the Presence of Esophagitis

Aims: This study aimed to compare the presence of atypical symptoms and signs of gastroesophageal reflux disease (GERD) in postmenopausal women with osteoporosis on long-term oral alendronate (ALN).

Methodology: One hundred and eighteen postmenopausal women, 59 on oral alendronate (cases) and 59 without using bisphosphonates (controls) were evaluated using a questionnaire of symptoms of gastroesophageal reflux and voice changes; voice capture using the Auditory Perceptive Assessment of Voice and Acoustic Evaluation of Voice. The voice was assessed by the GRBASI Scale and the acoustic measurement of voice by VoxMetria Software.

Results: The median age was 66.87 ± 7.78 years (cases 68.83 ± 7.55 and control 64.91 ± 8.01, p = 0.0073) ranging from 52 to 85 years. The median body mass index was 27.38 ± 4.63, and there was no significant difference between groups (cases 26.64 ± 4.81 and control 28.13 ± 4:46 p = 0.0833). A greater frequency of typical clinical manifestations of Gastro-esophageal reflux disease (GERD) was observed (98, 83.05%), in the case group (52; 88.14%) in the control group (46; 77.97%), but there was no statistically significant difference (p = 0.146). Although, there was a trend towards more esophagitis in the control group (9 / 15.25% vs 2/ 3.39%; p = 0.042), atypical symptoms of the globus pharyngeal, dysphagia, discomfort in the upper airways (UA) and odynophagia had significantly more referrals in the ALN group. The presence of voice changes (96; 81.36%), was more frequent in the cases (53; 89.83%) than in controls (43; 72.88%; p = 0.022).

Conclusion: In conclusion, we found an independent association between voice disorders and gastroesophageal reflux independent of the presence of esophagitis, with the long-term use of oral alendronate.