Quick Reference: Which Bisphosphonate?

Four options, each suited to different needs

Fosamax
alendronate
Form Weekly oral tablet
Holiday After 5 years; strong residual effect
Fractures
Vertebral Non-vertebral Hip
Most prescribed bisphosphonate. Most long-term safety data. Most common follow-on after anabolic treatment in clinical trials.
Actonel
risedronate
Form Weekly or monthly oral tablet
Holiday After 5 years; shorter residual than alendronate
Fractures
Vertebral Non-vertebral Hip
May have faster onset of fracture protection. Some patients tolerate it better than alendronate.
Boniva
ibandronate
Form Monthly tablet or quarterly IV
Holiday After 5 years
Fractures
Vertebral Non-vertebral Hip
Less robust evidence for non-vertebral and hip fracture reduction compared to the other three options.
Preferred after EVENITY
Reclast
zoledronic acid
Form Once-yearly IV infusion
Holiday After 3 years; potent residual
Fractures
Vertebral Non-vertebral Hip
No GI side effects. Annual dosing. Retains 73–87% of BMD gains after EVENITY. Also proven effective in osteopenia (Reid 2018).

How to Take Oral Bisphosphonates

Take first thing in the morning on an empty stomach with a full glass of plain water. Remain upright for at least 30 minutes — no eating, drinking, or other medications during that time. This protects your esophagus and ensures proper absorption.

MelioGuide.com • Discuss with your physician which option is right for you