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

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?
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.”