My aunt hasn't had any issues with the alendronate. My mother who is 82 quit alendronate in 2022. After having taken it for several years with no issues (I think she'd been on it for 4ish years), my mom started having some type of throat problem and felt nauseous and was having a hard time eating--after a few bites she would feel queasy and she could only eat very mild foods (apple sauce, scrambled eggs, pancakes, etc) and she had dry mouth, which is horrible for oral health, and she had to use Biotene. After my mother quit the alendronate, these issues went away so most likely it was the alendronate that was causing the problems.

During the 1.5 years that I took alendronate, in addition to the acid reflux and heartburn, I did experience some body aches that I think were caused by the alendronate. With my hypothyroidism, it is sometimes hard to figure out what is causing what LOL but when on the alendronate I felt like I had more bone pain. When I told my mother this, she asked how do you know it's your bones--technically, I couldn't prove it but that is what it seemed like, not sure if that makes sense.

The ob/gyn who recommended that I stop taking the Alendronate works mostly with older post-menopausal women and she told me that many of her patients have problems taking Alendronate.

Have you considered HRT? The general rule of thumb is w/i 10 years of menopause and younger that 60. I've been posting for 1.5 years now that I finally found a PA who is willing to prescribe HRT for me even though I don't meet the criteria--I'm more than 2 decades post menopause--but I haven't quite decided if I want to do it.
I know you are in your mid-60s but a very low dose HRT might help but there are risk, as with all things. I recently watched this http://tinyurl.com/2y2za3uc and Dr. Doug Lucas says that one of his patient's takes testosterone and had an increase in BMD. I plan to ask my PCP about this during my appt next week. Note, HRT is not approved for treating osteoporosis so to be prescribed HRT it has to be for reasons the FDA has approved it for if you want your insurance to potentially cover it. I've also read that some doctors think it's ok to take HRT for life. This link https://www.lancastergeneralhealth.org/health-hub-home/2021/september/is-hormone-therapy-safe-for-women-over-65 states 'According to Wulf Utian, MD, medical director for NAMS, “There may be safety concerns, and the Society does recommend that a woman use the lowest dose of hormones for the time appropriate to meet her needs. But we know that, under some circumstances, hormone therapy can be appropriate for women over age 65, such as those instances when the benefits of treating hot flashes outweigh the risks or when a woman has a high risk of bone fractures and can't take other bone drugs or can't withstand their side effects.” ' Personally, I think HRT sounds like a much better option than bisphosphonates, I just don't know if HRT will work for me.

You shared that you have Sjogren. I just searched for "Sjogren and alendronate" to see if there was any info regarding if ppl with sjogren should avoid oral bisphosphonates, what I found was this "Primary Sjogren syndrome increases the risk of bisphosphonate-related osteonecrosis of the jaw" link:
https://www.nature.com/articles/s41598-020-80622-5

I'm not posting this to scare or worry you. I like to be informed and I know my endocrinologist failed to tell me things and do things he should have prior to prescribing bisphosphonates for me.

If you read through the article above it states "The results indicated that patients with pSS using BPs had an approximately two-fold higher risk of BRONJ as compared with a non-pSS cohort. Therefore, we postulated that pSS increased the risk of BRONJ." Since the risk of ONJ is low, a two-fold higher risk is still low overall.

After my one and only zoledronic acid infusion, when I started doing my own research, I found articles that stated that people with Tori are at higher risk for BRONJ. I have tori. If you aren't familiar with this it's basically boney growths in your mouth. I have them both on the roof of my mouth and I have mandibular, tori behind my lower teeth. The tori rarely bother me, but it bothers me that my endocrinologist did not ask about my dental health prior to prescribing bisphosphonates, which he is supposed to do. Also, in my research, I found that people with hypothyroidism are at increased risk of osteonecrosis in general, meaning not just of the jaw. Again, it seems that my endocrinologist should have mentioned this.

You might want to take a look at this website https://www.bonehealthtech.com/ their device, the OsteoBoost Belt, was fast-tracked by the FDA a few years ago (their idea of fast and my idea of fast are very different LOL). I have literally been waiting for years for it to become available. A few weeks ago they posted "Recently, Bone Health Technologies filed for Class 2 Prescription De Novo Approval with the FDA and was previously awarded Breakthrough Device Status. BHT presented data from their clinical trial at ASBMR 2023 and ENDO 2023. The results of this double-blinded, sham-controlled design provided significant evidence supporting the efficacy of the Osteoboost in mitigating the decline of bone strength in post-menopausal women."

Originally, they were saying the OsteoBoost Belt would be available in mid-2022. About a week before they made their most recent announcement--tired of waiting with no updates--I reached out to the company and received an email reply that they are hoping to have it available by mid 2024. On their website, you can add your name to their mailing list to get notified of when the OsteoBoost Belt will be available via prescription.