Boniva, Fosamax, Actonel: Which One is Right for You?

I’ve long been aware that Sally Field (a.k.a. The Flying Nun, to those of us whose TV roots go back to the ’60s) is a spokeswoman for Boniva. Truth be told, she’s more huckster than spokesperson; her presence on TV and in print ads is near ubiquitous.

But until I started paying attention to osteoporosis, Boniva was just another one of those older-lady drugs whose warnings and unpleasant side effects regularly fill a complete magazine page with fine-print type. Boniva? Prempro? Prometrium? Whatever. Not for me. Until cancer drugs started eating away at my bones, and suddenly I had to pay attention.

For the past year, ever since a regular checkup revealed accelerating bone loss in my hip and spine, I’ve been exercising, lifting weights, consuming the recommended amounts of calcium and vitamin D, and doing everything I can to keep my bones healthy without resorting to drugs. Now, with my next DEXA scan coming up in 2 weeks, I find myself anxiously wondering if the lifestyle change hasn’t worked; if I will, finally, have to resort to an osteoporosis drug.

And if so—which one?

I’ve done some research, tackling the most common osteoporosis drugs first: the oral bisphosphonates. These have quite a reputation for unpleasant side effects; I’d love to avoid them. But if I have to give in and take a medication, I want to know ahead of time which one might suit me best. Thus my foray into oral bisphosphonates.

Are you facing this decision, too? Getting ready to try an oral bisphosphonate? Here’s a handy roundup of facts that might reveal which would be best for you; and what you can do to head off those nasty side effects.

Boniva 
Is it recommended for me?
Boniva is recommended for the prevention and treatment of osteoporosis in post-menopausal women. It isn’t recommended if you have kidney problems, or low blood calcium (hypocalcemia).

How will it help me?
Boniva increases bone density throughout the skeleton. It’s been shown to reduce the risk of spinal fractures by about 50% over three years, but hasn’t shown to be effective in reducing other fractures, such as hip or wrist.

When and how would I take it?
Boniva is taken once a month. It’s taken when you first get up, whole (no crushing the pill) on an empty stomach, with 8 ounces of water and nothing else. You must remain upright for 60 minutes after taking it to avoid side effects. For best absorption, it’s recommended that you not have calcium or iron supplements; vitamins with minerals; antacids, dairy products, mineral water, coffee, tea, calcium-enriched juice, or any food for at least 60 minutes after taking Boniva.

And what are the common side effects?
Most common side effects include upset stomach; diarrhea; and pain in your arms and legs. Other less common though possible side effects are trouble swallowing; heartburn; mild flu-like symptoms; and ulcers in your stomach or esophagus.

Finally, what’s the best way to avoid side effects?