I only took 7 Fosamax pills before I was changed off of it. I don’t know the least amount you need to take to satisfy the insurance company and doctor.

You might want to get alendronate, either free samples or a small number with prescription (it’s cheap) and take one. And document document document. And document that you followed protocol of no food, sitting up, and water intake. Leave no reason they can blame side effects on that you didn’t take it as prescribed. Maybe only one or two tablets is enough to demonstrate a side effect. All they need is a record saying it caused unacceptable side effects.

My experience was irritation in my throat about 2 hours after taking the pill. No amount of water changed that. And I never have had a reflux issue. I also got a simple case of conjunctivitis, pink eye. That seems to be a side effect that is not listed as frequent- but from the endocrinologist response it seemed important. So watch for irritation of your eye conjunctiva. I was not medically diagnosed with pink eye, but I’ve been around enough kids to know what it is. I self-reported the incidence to the doctor as it cleared up in 3 days without treatment.

I’d also tell the doctor you don’t want to continue to irritate your esophagus because it is a precursor to cancer. Most of the research I could find on alendronate back when I was faced with the same problem discussed side effects of the stomach. They never seemed to follow up on how the drug refuxes back up into the esophagus and the damage it causes.
If drinking water stopped reflux it would be a miracle cure!