Personalized Osteoporosis Treatment Advisor
Personalized Treatment Recommendations
Answer a few simple questions about your situation to find the best osteoporosis treatment option for you.
Fosamax has been a go-to prescription for osteoporosis for over two decades. But if you’re taking it now-or considering it-you’ve probably wondered: are there better options? Maybe you’re struggling with stomach upset, or you’ve heard about rare side effects like jaw bone problems. Or maybe you just want to know what else is out there that could work just as well-or better-for your bones.
The truth is, Fosamax isn’t the only drug that helps prevent fractures in people with thinning bones. In fact, since its launch in 1995, at least six other medications have been approved for osteoporosis, each with different benefits, risks, and ways of taking them. Some are pills like Fosamax. Others are shots, infusions, or even a nasal spray. The right choice depends on your health history, how well you tolerate side effects, and what your doctor thinks will keep your bones strongest over time.
How Fosamax Works
Fosamax is the brand name for alendronate, a bisphosphonate. These drugs slow down the cells that break down bone (osteoclasts), giving bone-building cells (osteoblasts) more time to do their job. Over months and years, this helps increase bone density, especially in the spine and hip-two areas most at risk for fractures.
It’s taken as a weekly pill, first thing in the morning, with a full glass of plain water. You have to stay upright for at least 30 minutes afterward and wait before eating or drinking anything else. That’s because alendronate can irritate the esophagus if it doesn’t get washed down quickly. Many people stop taking it because of this hassle-or because they get heartburn, stomach pain, or muscle aches.
Studies show Fosamax reduces spine fractures by about 44% and hip fractures by around 25% over three years in postmenopausal women. But it’s not perfect. Long-term use (over 5 years) may increase the risk of unusual thigh bone fractures, though this is rare-about 1 in 1,000 people over 10 years.
Alternatives to Fosamax: The Main Options
Here are the most common alternatives to Fosamax, grouped by how they work and how you take them.
Risedronate (Actonel, Atelvia)
Like alendronate, risedronate is a bisphosphonate. It works the same way but is often better tolerated by people with sensitive stomachs. You can take it weekly or monthly. Atelvia is a delayed-release version taken after breakfast, which reduces the need to wait 30 minutes before eating.
It’s slightly less effective than Fosamax at reducing spine fractures-about 35% vs. 44%-but just as good at preventing hip fractures. If you had trouble with Fosamax’s strict dosing rules, risedronate might be easier to stick with.
Ibandronate (Boniva)
Boniva comes as a monthly pill or a quarterly IV infusion. The pill version has fewer stomach side effects than Fosamax, but it’s not as strong at reducing spine fractures. The infusion, given once every three months at a clinic, avoids the digestive system entirely. That’s a big plus if you have GERD, esophagitis, or just hate swallowing pills.
Studies show Boniva reduces spine fractures by 50% over three years-slightly better than Fosamax. But it doesn’t show the same level of hip fracture protection, so it’s not always the first pick for people with very low hip bone density.
Zoledronic Acid (Reclast, Aclasta)
This is a once-a-year IV infusion. You get it in a doctor’s office over 15 to 30 minutes. No pills. No fasting. No waiting to eat. It’s one of the most effective osteoporosis drugs out there.
In a major 2007 study, Reclast reduced spine fractures by 70%, hip fractures by 41%, and non-spine fractures by 25% over three years. That’s better than Fosamax across the board. Side effects? Some people get flu-like symptoms for a day or two after the infusion-fever, muscle aches, fatigue. But those usually go away with acetaminophen.
It’s often recommended for people who can’t take oral meds, have trouble remembering pills, or need maximum protection after a fracture.
Denosumab (Prolia)
Prolia is a monoclonal antibody, not a bisphosphonate. It targets a different pathway in bone breakdown-RANKL-and blocks it completely. You get a shot under the skin every six months.
It’s more effective than Fosamax at increasing bone density and reducing fractures. One study showed a 68% drop in spine fractures and a 40% drop in hip fractures over three years. It’s especially helpful for people who’ve failed other treatments or have very low bone density (T-score below -3.0).
But there’s a catch: if you stop Prolia, bone loss can happen fast. That’s why you usually need to switch to another drug like a bisphosphonate if you discontinue it. Also, there’s a small risk of serious infections and skin reactions. Your doctor will monitor your calcium levels and may give you a vitamin D supplement to prevent low calcium.
Teriparatide and Abaloparatide (Forteo, Tymlos)
These are the only two osteoporosis drugs that actually build new bone instead of just slowing bone loss. They’re synthetic forms of parathyroid hormone. You give yourself a daily injection under the skin.
Forteo reduces spine fractures by 65% and non-spine fractures by 53%. Tymlos is similar but slightly more effective at increasing bone density. Both are used for severe osteoporosis-usually after other drugs have failed or if you’ve had multiple fractures.
They’re expensive. And you can only use them for up to two years total in your lifetime. After that, you usually switch to a drug like Prolia or a bisphosphonate to hold onto the gains.
Romosozumab (Evenity)
Evenity is the newest option. It’s a monthly injection for 12 months that both builds new bone and slows bone loss. It’s the only drug with this dual action.
In trials, it cut spine fractures by 73% and hip fractures by 38% over 12 months-better than any other drug tested. After the 12 months, you typically switch to a bisphosphonate or Prolia to maintain the results.
But it comes with a black box warning: increased risk of heart attack, stroke, or cardiovascular death. So it’s not for people with a history of heart disease or stroke. It’s also expensive and only approved for postmenopausal women with very high fracture risk.
Comparing All the Options
Here’s a quick look at how these drugs stack up:
| Medication | Form | Frequency | Spine Fracture Reduction | Hip Fracture Reduction | Key Pros | Key Cons |
|---|---|---|---|---|---|---|
| Fosamax (alendronate) | Pill | Weekly | 44% | 25% | Well-studied, low cost, long-term data | Strict dosing, GI side effects, rare thigh fractures |
| Risedronate (Actonel) | Pill | Weekly or monthly | 35% | 25% | Easier on stomach, flexible dosing | Less effective for spine than Fosamax |
| Ibandronate (Boniva) | Pill or IV | Monthly or quarterly | 50% | 18% | IV option avoids GI issues | Weak hip protection, pill form still causes heartburn |
| Zoledronic Acid (Reclast) | IV infusion | Yearly | 70% | 41% | Most effective, no daily pills, high compliance | Flu-like symptoms, requires clinic visit |
| Denosumab (Prolia) | Injection | Every 6 months | 68% | 40% | Very strong, no GI issues, good for kidney patients | Must continue indefinitely or switch; risk of rebound bone loss |
| Teriparatide (Forteo) | Injection | Daily | 65% | 53% | Builds new bone, best for severe cases | Only 2 years max use, expensive, daily shots |
| Romosozumab (Evenity) | Injection | Monthly x12 months | 73% | 38% | Fastest bone gain, dual action | Heart risk, only 12 months, very expensive |
Which One Is Right for You?
There’s no one-size-fits-all answer. But here’s how to think about it:
- If you’re healthy, have no stomach issues, and want the cheapest option with proven results: Fosamax still works.
- If you hate swallowing pills or get heartburn: Reclast (yearly IV) or Prolia (every 6 months shot) are better.
- If you’ve had a recent fracture and need fast, strong protection: Evenity or Forteo might be best-but only if you don’t have heart problems.
- If you’re older, have kidney issues, or can’t take oral meds: Prolia is often preferred.
- If you’re worried about long-term side effects: Risedronate or Boniva offer gentler alternatives with good results.
Your doctor will also look at your bone density score (T-score), your fracture history, your age, your kidney function, and whether you’re taking other medications. For example, if you’re on proton pump inhibitors (like omeprazole), Fosamax might not work as well-those drugs reduce stomach acid, which is needed for alendronate absorption.
What Happens If You Stop?
Stopping any osteoporosis drug without switching to another can lead to rapid bone loss. This is especially true for Prolia and Evenity. If you stop Prolia, you lose about 10% of your bone density in the first year. That’s why doctors usually plan a transition-like switching from Prolia to Reclast or Fosamax-before stopping.
With bisphosphonates like Fosamax, the drug stays in your bones for years after you stop. That’s why some people take a “drug holiday” after 5-10 years, especially if their bone density has improved and fracture risk is low. But you need to be monitored with regular scans during that time.
Non-Medication Support
No drug works alone. Calcium and vitamin D are essential. Most adults need 1,200 mg of calcium and 800-1,000 IU of vitamin D daily. If you’re not getting enough from food or sun, supplements are necessary.
Weight-bearing exercise-walking, dancing, stair climbing, resistance training-also helps strengthen bones. Avoid smoking. Limit alcohol to one drink a day. Fall-proof your home. These steps aren’t optional. They’re part of the treatment.
Frequently Asked Questions
Can I switch from Fosamax to another drug if I’m having side effects?
Yes, absolutely. Many people switch because of stomach upset, difficulty following dosing rules, or concerns about long-term use. Your doctor can help you transition safely-especially if you’re moving from a bisphosphonate to Prolia or an infusion. Never stop cold turkey without a plan.
Is Fosamax still the best choice for most people?
It’s still a solid, affordable option, especially for people with mild to moderate osteoporosis and no digestive issues. But for those with high fracture risk, poor adherence, or side effects, newer drugs like Reclast or Prolia often offer better protection and convenience.
Are there natural alternatives to Fosamax?
No. While calcium, vitamin D, and exercise support bone health, they don’t replace prescription drugs if you’ve been diagnosed with osteoporosis. Supplements like strontium or collagen peptides aren’t proven to prevent fractures. Don’t skip medication thinking a natural remedy will do the same job.
How often do I need a bone scan while on these drugs?
Most doctors recommend a DXA scan every 1-2 years while on treatment. If you’re on a bisphosphonate and doing well, you might wait 3-5 years. If you’re on Prolia or Evenity, scans are usually done after 12 months to track progress. Your doctor will adjust based on your risk level.
Can men take these drugs too?
Yes. While osteoporosis is more common in women, men over 70-or those with low testosterone, steroid use, or other risk factors-can also benefit from these medications. Reclast, Prolia, and Forteo are all approved for men. Fosamax is too, but it’s less commonly prescribed for men because they often have fewer GI symptoms with other options.
Next Steps
If you’re on Fosamax and unhappy, talk to your doctor about alternatives. Bring a list of your side effects, how often you miss doses, and what your biggest frustrations are. If you’re not on any medication yet but have low bone density, ask whether a stronger or easier option might be better for you.
Osteoporosis isn’t a quick fix. It’s a long-term condition that needs consistent care. The right drug can cut your fracture risk in half. But only if you take it-and stick with it. Don’t settle for the first option you’re given. Ask questions. Compare options. Your bones will thank you.
