Fosamax vs Boniva

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For patients with osteoporosis or other conditions leading to weakening of the bones, certain drugs that alter the process of bone formation and breakdown can help in slowing down bone loss and reducing the risk of bone fractures. Fosamax and Boniva are two such drugs that are prescribed for these conditions. They each impact different aspects of this process, but both have beneficial effects on bone density. Fosamax is a bisphosphonate medication that works by inhibiting osteoclast-mediated bone resorption, thereby increasing overall skeletal mass over time. Boniva, on the other hand, also falls under the class of bisphosphonates but has a longer duration between doses due to its ability to bind with hydroxyapatite binding sites in areas where there's high turnover rate in bones.

What is Fosamax?

Alendronate (the generic name for Fosamax) was one of the first drugs in the class of bisphosphonates, which represented a significant advancement from earlier treatments for bone loss and osteoporosis. Alendronate was first approved by the FDA in 1995. Fosamax works by slowing down bone breakdown, effectively increasing total mass and density over time. It is prescribed primarily to treat osteoporosis and prevent fractures in men and postmenopausal women.

On the other hand, Ibandronate (Boniva), another drug within this class introduced later on, has its unique perks. While both medications work similarly at their core, Boniva's dosing schedule can be more convenient with monthly dosage options as opposed to Fosamax's weekly regimen. However, side effects may vary between these two drugs with some patients experiencing fewer gastrointestinal issues with Fosamax than Boniva.

What conditions is Fosamax approved to treat?

Fosamax is approved for the treatment of various bone-related conditions including:

  • Osteoporosis in postmenopausal women
  • To increase bone mass in men with osteoporosis
  • Treatment of glucocorticoid-induced osteoporosis in men and women receiving glucocorticoids in a daily dosage equivalent to 7.5 mg or greater prednisone and who have low bone mineral density
  • Paget's disease of bone in men and women

How does Fosamax help with these illnesses?

Fosamax works to manage osteoporosis by slowing down the process of bone resorption, allowing the build-up of new bone tissue in the body. It does this by inhibiting a type of cell called osteoclasts that break down old or damaged bone, so new bone can be created more quickly than it's broken down. Bone is a living tissue that is constantly being renewed and reshaped; however, as we age or due to certain medical conditions, the balance between breakdown and creation can become skewed leading to diseases like osteoporosis. Fosamax aims at restoring this balance by limiting bone loss which helps patients maintain their skeletal health and decrease fracture risk.

Boniva functions similarly but has different dosing schedules compared to Fosamax (monthly instead of weekly), which may improve patient compliance.

What is Boniva?

Boniva, a brand name for ibandronate, is a bisphosphonate medication that acts by inhibiting the activity of osteoclasts, cells responsible for bone resorption. This action helps to increase bone density and prevent fractures in individuals with osteoporosis. It was first approved by the FDA in 2003. Boniva differs from other bisphosphonates such as Fosamax (alendronate) in its administration schedule; it can be taken monthly instead of daily or weekly which some patients may find more convenient. Its side effects are similar to those of other bisphosphonates including gastrointestinal upset and risk of jaw necrosis, though these are relatively rare occurrences. The choice between Boniva and another drug like Fosamax often comes down to personal preference regarding dosage frequency and individual tolerance to potential side effects.

What conditions is Boniva approved to treat?

Boniva has been given approval by the FDA for the treatment of specific conditions, which include:

  • Osteoporosis in postmenopausal women
  • Prevention of osteoporosis in postmenopausal women This drug is designed to slow bone loss, increase bone density and reduce the risk of spine and non-spine fractures.

How does Boniva help with these illnesses?

Boniva, like Fosamax, is a bisphosphonate and plays a crucial role in the regulation of bone metabolism. It works by slowing down the process of bone breakdown, thereby increasing bone density and reducing the risk of fractures. The hormone calcitonin is involved in this process, helping to regulate levels of calcium and phosphate in the blood and promoting the growth and strength of bones. Boniva's effect on osteoclasts - cells that break down bone - may play an important role in its action as an osteoporosis treatment drug. Compared to Fosamax which requires daily dosage, it offers more convenience with monthly dosing for patients who aren't responding well or forgetting their daily osteoporosis medication regimen.

How effective are both Fosamax and Boniva?

Both alendronate (Fosamax) and ibandronate (Boniva) are well-established in the treatment of osteoporosis, having been approved by the FDA only three years apart. Both drugs work by inhibiting bone resorption, leading to an increased total amount of bone and a decreased likelihood of fracture. The effectiveness of both was directly observed in two separate trials: the Fracture Intervention Trial for Fosamax in 1998 and the BONE study for Boniva in 2005; each drug demonstrated strong efficacy at reducing fracture risk.

A review published in 2012 reported that Fosamax is effective at reducing fractures within just one year of starting treatment, showing a favorable safety profile compared to other treatments available. It has since become one of the most widely prescribed osteoporosis medications globally. The recommended dose for optimal efficacy is generally considered as 70 mg once weekly, although daily dosing options are also available.

The same cannot be said about Boniva which doesn't have as robust data supporting its use as Fosamax does. However, it seems to reduce fracture risk comparably effectively when used correctly - typically administered either monthly or even less frequently via intravenous infusion depending on patient preference or tolerability issues with oral administration. This unique dosing schedule can provide advantages over other bisphosphonates like Fosamax especially for patients who may struggle with adherence due to daily or weekly medication regimens so long as kidney function is adequate given potential renal clearance concerns with less frequent dosing.

abstract image of a researcher studying a bottle of drug.

At what dose is Fosamax typically prescribed?

Oral dosages of Fosamax range from 5–70 mg/day, depending on the condition being treated. For osteoporosis in postmenopausal women and men, a daily dose of 10 mg or a weekly dose of 70 mg is recommended. In contrast, Boniva is usually taken as one 150mg tablet once monthly for treatment or prevention of osteoporosis in postmenopausal women. The dosage can be altered according to therapeutic response and tolerance. However, exceeding the prescribed dosage should be avoided under all circumstances.

At what dose is Boniva typically prescribed?

Boniva treatment for osteoporosis is typically started at a dosage of 150 mg once per month. For those who are unable to swallow tablets, an intravenous option is available. This involves receiving a dose of 3mg over the course of 15-30 seconds every three months, administered by a healthcare professional. It's essential that patients follow their doctor's instructions and continue taking Boniva even if they feel well, as osteoporosis often has no noticeable symptoms until a bone fracture occurs. If there isn't any significant improvement or if the condition worsens after several months of treatment, your healthcare provider may need to reassess your medication regimen.

What are the most common side effects for Fosamax?

Common side effects of Fosamax can include:

  • Heartburn, difficulty swallowing or pain upon swallowing
  • Stomach discomfort, nausea
  • Bone, muscle or joint pain
  • Headache
  • Dizziness
  • Eye inflammation (pain or redness)

Meanwhile Boniva may cause:

  • Back pain, arm or leg discomfort
  • Flu-like symptoms such as fever and chills
  • Nausea, diarrhea
  • Abdominal distention and bloating,
  • Bronchitis (inflammation in the bronchial tubes),
  • Pneumonia (infection in one or both lungs),
  • Urinary tract infections, Hypertension(high blood pressure)

Remember to contact your healthcare provider if any of these side effects persist for a prolonged period. They will help you decide whether the potential benefits outweigh the risks involved with using either medication.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Fosamax?

In rare instances, serious side effects can occur with use of Fosamax and Boniva. These may include:

  • Signs of an allergic reaction: difficulty breathing; swelling in your face, lips, tongue or throat
  • Unusual pain in thigh or hip: A small number of people have developed unusual fractures in their thigh bone. Report any unusual bone pain to your doctor.
  • Jaw pain, numbness or swelling: Rarely, these drugs can cause severe jawbone problems (osteonecrosis).
  • Heartburn-like symptoms and chest pain.
  • New or worsening heartburn
  • Difficulty swallowing
  • Painful swallowing
  • Chest discomfort that worsens when you bend over or lie down Severe joint/bone/muscle ache.

If you experience any of the above side effects while taking Fosamax or Boniva, stop using the medication immediately and consult your healthcare provider as soon as possible.

What are the most common side effects for Boniva?

Boniva, like any medication, can induce some side effects. Some of the most frequently reported include:

  • Headache or dizziness
  • Redness or warmth in your face, neck, arms, and occasionally chest (flushing)
  • Upset stomach or indigestion
  • Pain in the back, arms or legs
  • Diarrhea
  • Eye pain and severe joint/bone/muscle pain While these are common symptoms that may occur when taking Boniva, it is important to note that more serious side effects are possible. Always consult with a healthcare professional for guidance about potential risks associated with medications.

Are there any potential serious side effects for Boniva?

Boniva, like Fosamax, is a medication used to treat osteoporosis. While generally safe, there can be concerning side effects in some cases:

  • Allergic reactions: signs may include rash or itching skin; fever; swollen glands; hoarseness; difficulty in swallowing or breathing; swelling of the mouth, face, lips, tongue or throat.
  • Unusual thigh bone fractures: severe pain in your hip or thighs.
  • Eye inflammation: redness and painful eyes with light sensitivity and blurred vision.
  • Bone loss in the jaw (osteonecrosis): symptoms could include jaw pain, swelling and numbness, loose teeth and infection.
  • Heartburn-like symptoms or chest pain that worsens when lying flat
  • Severe joint/bone/muscle pains

Should you experience any of these side effects while taking Boniva it is crucial to immediately consult your healthcare provider.

Contraindications for Fosamax and Boniva?

Both Fosamax and Boniva, as with most other osteoporosis medications, may cause side effects in some people. If you notice any unusual symptoms such as difficulty swallowing, new or worsening heartburn, chest pain or severe bone/joint/muscle pain please seek immediate medical attention.

Neither Fosamax nor Boniva can be taken if you have low blood calcium levels (hypocalcemia) or problems with the movement of muscles in your esophagus. Always tell your physician which medications you are taking; certain drugs including aspirin and other NSAIDs might interact negatively with these osteoporosis treatments.

Fosamax is usually prescribed to take once a week while Boniva is taken once a month. This difference might make one medication more appealing than the other depending on your personal preference for dosage frequency.

How much do Fosamax and Boniva cost?

For the brand name versions of these drugs:

  • The price for a monthly dose of Fosamax (70 mg), which is taken once weekly, averages around $170 to $220. This works out to roughly $5.50 - $7/day.
  • Boniva (150 mg), also taken once a month, has an average cost between $200 and $250 per dose, equaling about $6.50 - 8/day.

Therefore, if you're considering brand-name options only, Fosamax costs slightly less on a daily basis than Boniva does. However, it's critical to remember that price should not be your sole deciding factor when choosing between these two osteoporosis medications.

For the generic versions of Fosamax (alendronate) and Boniva (ibandronate):

  • Alendronate comes in packs with four tablets each (70 mg). The cost ranges from approximately $.75 to $2 per week depending on the pharmacy and insurance plan specifics ($0.11 – 0.$30/day).
  • Ibandronate costs are similar ranging from around $.60 up to nearly$2 per tablet for a pack of three tablets or one month’s supply ($.02 – $.07/day).

Both generics represent significant savings compared with their respective branded counterparts while offering comparable treatment outcomes.

Popularity of Fosamax and Boniva

Alendronate, commonly known by the brand name Fosamax, was prescribed to about 3 million people in the US in 2020. Alendronate is responsible for just over 15% of all bisphosphonates prescriptions in the country. It has been a long-standing favored choice among healthcare professionals when it comes to treating osteoporosis and preventing fractures since its approval by FDA back in 1995.

Ibandronate, also recognized as Boniva, was given to approximately 1 million individuals during that same year. In terms of overall bisphosphonates prescriptions within the States, ibandronate accounts for nearly 5%. Although being another effective option for managing osteoporosis and preventing bone fractures, it's less often prescribed compared with alendronate possibly due to its later introduction (FDA approved ibandronate in March 2003) and more complex dosage regimen.


Both Fosamax (alendronate) and Boniva (ibandronate) are well-established in the treatment of osteoporosis, with numerous clinical studies showing their effectiveness over placebo treatments. There might be instances where these drugs may be used together, but this should only be under careful consideration by a physician due to potential interactions between them. With differing mechanisms of action - both being bisphosphonates that work by slowing bone loss to increase bone mass and potentially reduce fracture risk - they are prescribed based on specific patient needs.

Fosamax is often considered as a first-line treatment option due its once-weekly dosing schedule, whereas Boniva is usually considered for patients who prefer or require less frequent dosing schedules as it's taken monthly.

Both medications come in generic form which represents significant cost savings especially for those paying out of pocket. Both Fosamax and Boniva may take time before noticeable effects occur since they slowly affect the rate of bone turnover.

The side effect profiles are relatively similar between the two drugs - most commonly including gastrointestinal issues such as heartburn or upset stomach, though rare but serious side effects like jawbone problems can occur. For these reasons, patients must closely monitor any changes or discomforts while on either medication and seek medical help immediately if any severe symptoms arise.