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

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).

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.