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“Dear Editors, Very likely some clinical trials on alendronate in tablets, taken with tap water (the possibility of using distilled water was not envisaged), do not report the real activity of the product, for the following reasons. In the Physician’s Desk Reference , it is stated that Fosamax must be taken with tap water only and not with mineral water (the word “not” is printed in bold type) since other beverages, including mineral water, are likely to reduce its absorption by as much as 60% due to their content of calcium and other cations [2, 3]. The package insert of Fosamax in Italy, but most probably not only in Italy, has integrally reproduced this statement, saying that the product “must be taken with tap water only and not with mineral water.” The most authoritative Martindale  writes that “absorption is decreased by food, especially by products containing calcium or other polyvalent cations”.