First, I use ripmime to dump every single attachment to a folder with dated naming - and so if there is an email in pine with an attachment I want to view, I just web browse a simple apache directory listing and click it. It's not sexy, but it's fast and efficient.
Second, I have a terminal PDF reader installed on my system and defined in alpine as a helper app for pdf files. So I cannot read word or excel right in alpine but I can read PDF docs. So that's nice and slick.
Finally, I never actually click links in alpine, but I defined lynx as a web viewer anyway because that allows me to get the very simple "do you want to view this http link ?" prompt from alpine ... which I always say NO to, but not until I have copied the full URL which they display for me. Then I just open it in a browser.
Fairly happy with this setup.