Boniva vs. Forteo
See how Boniva and Forteo compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Boniva is a once-monthly oral bisphosphonate that slows bone breakdown, while Forteo is a daily injection that stimulates new bone growth.
Forteo is typically reserved for higher-risk osteoporosis, including in men and glucocorticoid-induced cases, while Boniva is approved only for postmenopausal women.
Boniva costs far less per month than Forteo, which requires self-injection and closer monitoring for calcium levels and blood pressure.
Boniva vs. Forteo Drug Summary
Boniva
Boniva (ibandronate) is a nitrogen-containing bisphosphonate used to treat and prevent osteoporosis in postmenopausal women. It works by slowing the cells that break down bone, and it is taken as a single tablet once a month, on an empty stomach, followed by 60 minutes upright.
Forteo
Forteo (teriparatide) is a parathyroid hormone analog used for osteoporosis in postmenopausal women, certain men, and people on long-term steroids who are at high fracture risk. Unlike bisphosphonates, it actively builds new bone, and it is given as a daily injection using a prefilled pen.
Boniva vs. Forteo Side Effects
Boniva
Forteo
Boniva vs. Forteo Dosage
Boniva
Forteo
| STAGE | DOSE | WHEN |
| Starting dose | 150 mg once monthly | At the start |
| Maximum dose | 150 mg once monthly | Same as starting |
| Dose changes | None | Fixed dose |
| 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 |
Boniva
| STAGE | DOSE | WHEN |
| Starting dose | 150 mg once monthly | At the start |
| Maximum dose | 150 mg once monthly | Same as starting |
| Dose changes | None | Fixed dose |
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 |
Boniva vs. Forteo Indications
Boniva
Boniva is FDA-approved for both treating and preventing osteoporosis in postmenopausal women. It is not approved for use in men or in children.
Treatment of postmenopausal osteoporosis
Prevention of postmenopausal osteoporosis
Once-monthly oral dosing
Forteo
Forteo is approved for postmenopausal women and certain men at high risk of fracture, as well as for glucocorticoid-induced osteoporosis. It is generally reserved for patients who need more than just slowed bone loss.
Postmenopausal osteoporosis at high fracture risk
Osteoporosis in men at high fracture risk
Glucocorticoid-induced osteoporosis
Boniva vs. Forteo Pros and Cons
Boniva
Boniva is a convenient oral option with decades of use and a much lower cost, making it accessible for long-term maintenance therapy. It slows further bone loss but does not build new bone, so it is often not preferred for patients with severe or high-risk osteoporosis.
Pros
Oral tablet, no injections needed
Only taken once a month
Roughly $155 to $285 per month before insurance
Cons
Requires staying upright for 60 minutes after dosing
Not recommended with severe kidney impairment
Small risk of atypical femur fractures with long-term use
Does not build new bone, only slows bone loss
Forteo
Forteo actively builds new bone rather than just slowing loss, which makes it an option for patients at higher fracture risk or who haven't responded to other treatments. It requires a daily injection and carries a significantly higher cost, along with its own set of monitoring needs.
Pros
Builds new bone rather than only slowing loss
Approved for men and glucocorticoid-induced osteoporosis
Boxed warning for osteosarcoma removed from label in 2021
Cons
Daily self-injection required
Roughly $4,590 to $5,100 per month before insurance
Can cause dizziness or low blood pressure after initial doses
Risk of elevated calcium levels or skin calcification
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