Hi Pauline, welcome and thanks for your question.  When the manufacturer mentions difficulty swallowing they are generally referring to someone who has esophagitis from acid reflux or some other disorder that causes someone to have great difficulty swallowing or very painful swallowing.   Here's a link from our site on Fosamax that explains this in more detail.  People with swallowing problems usually have trouble with foods and liquids, but to be sure I'd ask your Dr. or Pharmacist what they mean by this.   If you are worried about the oral pill, you could ask your Dr. for a sample of it and see if you have any trouble swallowing it.  The pill is pretty small, and needs to be taken with water only before you eat anything (empty stomach) and be sure to stay upright for the recommended time.  When I took Actonel I didn't have any trouble with it and I took it in the morning once a week.  I do have trouble swallowing very large or uncoated vitamins, but this isn't what they mean by difficulty swallowing.  The problem they are referring to is a medical disorder that some have that I've mentioned above.   Good luck and if you could try the sample then you'd know ahead of time if the liquid form is needed.  Most Dr.'s will give you a month or several weeks supply free so you could try it.  Just check with the Dr. or Pharmacist to confirm this issue of trouble swallowing.