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

PJ Hamel Health Guide
  • 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.

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    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?
    Take Boniva first thing in the morning, and follow the directions carefully: take with 8 ounces water on an empty stomach; nothing else to eat or drink for 1 hour; and stay upright (sitting, standing, walking) for at least 1 hour. If you have to lie down after 1 hour, be sure to eat something first.


  • Bottom line

    Pros: You only take it once a month.
    Cons: You have to wait 60 minutes after taking it (double the usual wait) to eat or drink anything, or lie down. It’s only effective against spinal fractures. It takes up to 2 years to kick in.

    Fosamax
    Is it recommended for me?
    Fosamax is recommended for the prevention and treatment of osteoporosis in post-menopausal women, and men. This includes women and men treated whose bone loss is induced by the use of steroid drugs for diseases such as asthma, rheumatoid arthritis, and other autoimmune diseases. Fosamax is also recommended for those with Paget’s disease of the bone. You shouldn’t take Fosamax if you have esophagus problems; severe kidney disease, or low blood calcium (hypocalcemia).

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    How will it help me?
    Fosamax increases bone density throughout the skeleton. It’s been shown to reduce the risk of spinal fractures and hip fractures, beginning at about 2 years after onset of treatment. It doesn’t lessen the possibility of other types of fractures.

    When and how would I take it?
    Fosamax can be taken daily or weekly. 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 30 minutes after taking it to avoid side effects. For best absorption, it’s recommended that you not have vitamins, antacids, coffee, tea, soda, mineral water, or any food for at least 30 minutes, and preferably 1 to 2 hours, after taking Fosamax.

    And what are the common side effects?
    Most common side effects include mild stomach pain, indigestion, gas, and nausea. Other 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?
    Take Fosamax first thing in the morning, and follow the directions carefully: take with 8 ounces water on an empty stomach; nothing else to eat or drink for 30 minutes; and stay upright (sitting, standing, walking) for at least 30 minutes. If you have to lie down after 30 minutes, be sure to eat something first.

    Bottom line

    Pros: Joint pain isn’t listed as a side effect, unlike for other bisphosphonates.
    Cons: It works to prevent spinal and hip fractures, but not those in other areas (wrist, leg, etc.). There seems to be a slightly increased risk of ONJ (see below), compared to other bisphosphonates. It takes a couple of years to build up to where it provides protection. It has to be taken daily or weekly; there’s no option for taking it less frequently.

    Actonel
    Is it recommended for me?
    Actonel is recommended for the prevention and treatment of osteoporosis in post-menopausal women, and men. This includes women and men treated whose bone loss is induced by the use of steroid drugs for diseases such as asthma, rheumatoid arthritis, and other autoimmune diseases. Actonel is not recommended if you’re pregnant or breast-feeding; or if you have kidney problems.

    How will it help me?
    Actonel increases bone density throughout the skeleton. It’s been shown to reduce the risk of spinal fractures and hip fractures, as well as wrist, pelvis, clavicle, leg, and humerus fractures, all within the first year of treatment.


  • When and how would I take it?

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    Actonel can be taken daily; weekly; for two consecutive days once a month; or monthly. 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 30 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, calcium-enriched juice, or any food for at least 30 minutes after taking Actonel.

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

    Finally, what’s the best way to avoid side effects?
    Take Actonel first thing in the morning, and follow the directions carefully: take with 8 ounces water on an empty stomach; nothing else to eat or drink for 30 minutes; and stay upright (sitting, standing, walking) for at least 30 minutes. If you have to lie down after 30 minutes, be sure to eat something first.

    Bottom line
    Pros: It begins to provide protection almost immediately. It works on your entire skeleton, not just spine and/or hip. There’s a lot of flexibility in the schedule (daily, weekly, 2 days once a month, or monthly).
    Cons: Possible side effects include joint pain, along with the usual gastrointestinal issues.

    Note: One rare but serious side effect for all three of these bisphosphonates—and especially Fosamax—is osteonecrosis of the jaw (ONJ), the death of bone cells in the jawbone or surrounding tissues. This is painful, and can actually destroy your jaw. 

    You should tell your dentist you’re taking a bisphosphonate. He or she may need to take special precautions if you‘re having a tooth extracted, due to the possibility of ONJ. Also, while taking bisphosphonates you may find that you’re more prone to mouth infections; and your mouth may take longer to heal if you have a tooth extracted.

    So, which bisphosphonate is best for you? Speak with your doctor; (s)he might have a recommendation based on the specifics of your case. But if not, it’s up to you to choose.

     

    Me? My gut says Actonel. But the answer I’m still hoping for is “none of the above.”

Published On: November 06, 2008