Actonel vs. Forteo
See how Actonel and Forteo compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Actonel is an oral bisphosphonate that slows bone breakdown, while Forteo is an injectable hormone therapy that actively builds new bone.
Actonel offers flexible daily, weekly, or monthly dosing, while Forteo requires a daily injection with no dosing alternatives.
Actonel costs a fraction of Forteo's monthly price, but Forteo may be preferred for patients at very high fracture risk who need bone-building therapy.
Actonel vs. Forteo Drug Summary
Actonel
Actonel (risedronate) is an oral bisphosphonate that slows bone breakdown to treat and prevent osteoporosis in postmenopausal women, men, and patients on long-term glucocorticoids. It's taken as a pill on a daily, weekly, twice-monthly, or monthly schedule, depending on the regimen chosen.
Forteo
Forteo (teriparatide) is an injectable parathyroid hormone analog that actively builds new bone, used for postmenopausal women, men, and glucocorticoid-induced osteoporosis at high fracture risk. It's given as a once-daily subcutaneous injection using a prefilled pen.
Actonel vs. Forteo Side Effects
Actonel
Forteo
Actonel vs. Forteo Dosage
Actonel
Forteo
| STAGE | DOSE | WHEN |
| Starting dose | 5 mg once daily | At the start |
| Maximum dose | 150 mg once monthly | If needed |
| Dose changes | 4 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 20 mcg once daily | At the start |
| Maximum dose | 20 mcg once daily | Same as starting |
| Dose changes | None | Fixed dose |
Actonel
| STAGE | DOSE | WHEN |
| Starting dose | 5 mg once daily | At the start |
| Maximum dose | 150 mg once monthly | If needed |
| Dose changes | 4 increases | As tolerated |
Forteo
| STAGE | DOSE | WHEN |
| Starting dose | 20 mcg once daily | At the start |
| Maximum dose | 20 mcg once daily | Same as starting |
| Dose changes | None | Fixed dose |
Actonel vs. Forteo Indications
Actonel
Actonel is a bisphosphonate used to treat and prevent osteoporosis in postmenopausal women, increase bone mass in men, and manage glucocorticoid-induced bone loss. It's also one of the few therapies approved for Paget's disease of bone.
Treatment and prevention of postmenopausal osteoporosis
Increase bone mass in men with osteoporosis
Treatment and prevention of glucocorticoid-induced osteoporosis
Forteo
Forteo is a bone-building parathyroid hormone therapy for men and women with osteoporosis who are at high risk of fracture. It's approved for postmenopausal women, men with primary or hypogonadal osteoporosis, and glucocorticoid-induced bone loss.
Postmenopausal osteoporosis with high fracture risk
Increase bone mass in men with primary or hypogonadal osteoporosis
Glucocorticoid-induced osteoporosis at high risk of fracture
Actonel vs. Forteo Pros and Cons
Actonel
Actonel is a well-established oral bisphosphonate with decades of safety data and multiple dosing options to fit different routines. As a generic, it's far less expensive than anabolic options like Forteo, though it works by slowing bone loss rather than building new bone.
Pros
Oral tablet, no injections needed
Multiple dosing schedules (daily, weekly, monthly)
Approved for Paget's disease, unlike Forteo
Cons
Requires strict routine: empty stomach, upright 30+ minutes
Risk of esophageal irritation and rare jaw osteonecrosis
Antiresorptive only, doesn't build new bone like Forteo
Forteo
Forteo actively builds new bone rather than just slowing its breakdown, making it a good option for patients at high fracture risk who haven't responded to other therapies. It requires a daily injection and costs significantly more than oral bisphosphonates like Actonel.
Pros
Builds new bone rather than just slowing loss
No boxed warning since the 2021 label update removed it
Simple once-daily injection with no food or timing rules
Cons
Daily injection, which some patients find inconvenient
Not for use in Paget's disease or those at osteosarcoma risk
Roughly $4,590 to $5,100 per month without insurance, much higher than Actonel
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