Easier-on-the-Stomach Bisphosphonates

Patient Expert

If you've taken, are taking, or have been advised to take a bisphosphonate drug (Boniva ®, Fosomax ®, Actonel ®) for osteoporosis, you're probably aware that these drugs come with a host of side effects and challenges around how they're administered. While not everyone who takes these drugs has problems, the issues are common enough that it's estimated 50% of women who take them fail to finish the full course, or don't take them as recommended.

Fellow blogger Pam Flores has highlighted research into a new delivery system for these drugs, one that would allay the heartburn, nausea, and gastritis often associated with taking them. But that's a ways down the road; promising, but not here yet. In the meantime, there's the intravenous delivery option available with two bisphosphonates: Boniva IV, and Reclast.

Why should you consider taking Boniva IV or Reclast, vs. an oral bisphosphonate?

An injection of Boniva or Reclast goes right into your bloodstream, completely bypassing your gastrointestinal system. This eliminates the common side effects of bisphosphonates: stomach pain, indigestion, gas, heartburn, and nausea, as well as the less common side effect of esophageal and stomach ulcers.

This alone is huge; who wants to take drugs that make you feel awful? That's the case with many of us trying to stomach a bisphosphonate, and taking these drugs via injection seems like a sensible solution.

In addition, oral bisphosphonates need to be taken in a strictly regimented way: on an empty stomach (preferably first thing in the morning), with 8 ounces of water, without eating or drinking for 30 to 60 minutes afterwards, and remaining upright (no lying down) for the same amount of time. This helps push these drugs through your stomach and into your intestines (where they can be absorbed) as quickly as possible, helping to alleviate gastric issues.

But many patients have trouble with this schedule, for whatever reason. It's fairly inflexible, and demands diligence; many patients report cessation of these drugs simply because they can't manage to follow the directions 100% of the time. If you're a person who has trouble following a set process with regularity, an injection might be the answer. (So long as you can remember to get yourself to the doctor or hospital.)

Finally, there are folks who simply can't swallow pills. For most pills or tablets, crushing and mixing with yogurt or pudding may be an option; but bisphosphonates can't be crushed, as that worsens their side effects. So if you're a person who can't swallow pills, but needs a bisphosphonate, consider an injection.

Convinced you should take an IV bisphosphonate? Here's a comparison of your two options.

Reclast (zoledronic acid, zoledronate; Aclasta in Europe)
Is it recommended for me?
Reclast received FDA approval for treatment of osteoporosis in post-menopausal women in August, 2007. Reclast is the only osteoporosis treatment that's FDA-approved for prevention of further fractures after a hip fracture. For more information on the effectiveness of this drug, please read Pam Flores' post on Reclast.

How will it help me?
Reclast, like all bisphosphonates, increases bone density. It's been shown to reduce the risk of fractures of the vertebrae (70% reduction), hip (41% reduction), and other bones, such as wrist (25% reduction), compared to patients not taking any osteoporosis drugs.

How would I take it?
Reclast is given via a 15-minute injection, once a year. In addition, it's recommended post-menopausal women take a daily dose of 1200mg of calcium and 400-800 IU vitamin D3 throughout the year.

What are the common side effects?
The most common side effects of Reclast are flu-like symptoms: fever, muscle and/or joint pain, and headache. Less common side effects are severe bone and muscle pain; eye inflammation, and possible kidney damage. Uncommon though possible serious side effects include atrial fibrillation (irregular heart rhythm), and jaw damage. Your doctor may recommend you have a dental exam for preventive tooth and gum care before taking Reclast, as it can interfere with healing after a tooth extraction or other invasive dental procedure.

Boniva IV (ibandronate sodium)
Is it recommended for me?
Boniva IV received FDA approval for treatment of osteoporosis in post-menopausal women in January 2006.

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%, but hasn't shown to be effective in reducing other fractures, such as hip or wrist.

How would I take it?
Boniva IV is given via a 15- to 30-second injection once every 3 months (four times per year).

What are the common side effects?
Common side effects of Boniva IV include headache, stomach upset, and flu-like symptoms: fever, chills, fatigue, and joint/muscle aches. An uncommon, though serious side effect is jaw damage. Tell your dentist if you're going to take Boniva IV, as it may interfere with healing after a tooth extraction or other invasive dental procedure.

Bottom line

-Reclast is injected just once a year, vs. four times a year for Boniva IV.

-Reclast is effective against all kinds of fractures; Boniva IV is approved only for prevention of hip fractures.

-A rare side effect of Reclast is heart problems.

-Both Reclast and Boniva IV have been linked to serious (though very rare) jaw problems.