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To the Editor: Between the time of the initial marketing of alendronate in October 1995 through mid-May 2008, the Food and Drug Administration (FDA) received reports of 23 patients in the United States receiving a diagnosis of esophageal cancer, with alendronate (Fosamax, Merck) as the suspect drug (in 21 patients) or the concomitant drug (in 2 patients). No similar U.S. reports for other oral bisphosphonates were retrieved from the FDA's database for adverse-event reporting. Eight deaths were reported. Of the 23 patients, 18 (78%) were women; the median age was 74.0 years (mean, 71.8; based on 19 patients).