Fosamax vs. Actonel

See how Fosamax and Actonel compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Fosamax and Actonel are both bisphosphonates that slow bone loss and must be taken on an empty stomach with a full glass of plain water while sitting or standing upright.

  • Fosamax's most common side effects are gastrointestinal, like abdominal pain and dyspepsia, while Actonel's most common side effects are musculoskeletal, like pain in the arms or legs and back pain.

  • Generic Fosamax typically costs far less per month than brand-name Actonel, though both require staying upright for at least 30 minutes after each dose.

Fosamax vs. Actonel Drug Summary

Fosamax

Fosamax (alendronate) is an oral bisphosphonate used to treat and prevent osteoporosis in postmenopausal women, increase bone mass in men, and manage Paget's disease of bone. It is taken as a daily or weekly tablet, or as an oral solution, first thing in the morning on an empty stomach.

Actonel

Actonel (risedronate) is an oral bisphosphonate approved to treat and prevent osteoporosis in postmenopausal women, increase bone mass in men, and manage Paget's disease of bone. It comes in daily, weekly, twice-monthly, or monthly tablets, also taken on an empty stomach first thing in the morning.

Fosamax vs. Actonel Side Effects

Fosamax

Most common
abdominal pain (1% to 10%)
dyspepsia (1% to 10%)
nausea (1% to 10%)
diarrhea (1% to 10%)

Actonel

Most common
pain in extremity (up to 21%)
headache (up to 20%)
back pain (up to 17%)
generalized pain (up to 15%)

Fosamax vs. Actonel Dosage

Fosamax

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 5 mg once daily At the start
Maximum dose 70 mg once weekly If needed
Dose changes 4 increases As tolerated

Actonel

Dosage
Dosage Table
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

Fosamax vs. Actonel Indications

Fosamax

Fosamax is FDA-approved to treat and prevent osteoporosis in postmenopausal women, to increase bone mass in men with osteoporosis, and to treat osteoporosis caused by long-term steroid use. It is also approved for Paget's disease of bone.

  • Treatment of osteoporosis in postmenopausal women

  • Prevention of osteoporosis in postmenopausal women

  • Increasing bone mass in men with osteoporosis

  • Treatment of glucocorticoid-induced osteoporosis

Actonel

Actonel is FDA-approved to treat and prevent osteoporosis in postmenopausal women, to increase bone mass in men with osteoporosis, and to both treat and prevent osteoporosis caused by long-term steroid use. It is also approved for Paget's disease of bone in men and women.

  • Treatment and prevention of postmenopausal osteoporosis

  • Increasing bone mass in men with osteoporosis

  • Treatment and prevention of glucocorticoid-induced osteoporosis

  • Treatment of Paget's disease of bone in men and women

Fosamax vs. Actonel Pros and Cons

Fosamax

Fosamax has the longest track record of any oral bisphosphonate for osteoporosis, FDA-approved in 1995 and generic since 2008, which keeps its cost low. It comes in tablet and oral solution forms, but only offers daily or weekly dosing schedules.

Pros

  • Costs roughly $166 to $210 per month as a generic, versus $340 to $483 for Actonel

  • FDA-approved since 1995, giving it decades of real-world safety data

  • Available as an oral solution for patients who cannot swallow tablets

Cons

  • Only daily or weekly tablets, fewer scheduling options than Actonel's four regimens

  • Not approved to prevent glucocorticoid-induced osteoporosis, only to treat it

  • Higher renal cutoff (CrCl below 35 mL/min) excludes more kidney-impaired patients than Actonel

Actonel

Actonel offers more dosing flexibility, with daily, weekly, twice-monthly, and monthly tablet options, and its renal cutoff allows use in patients with slightly more advanced kidney impairment. Brand-name Actonel typically costs much more per month than generic Fosamax.

Pros

  • Usable down to a lower creatinine clearance (30 mL/min) than Fosamax's 35 mL/min cutoff

  • Offers four dosing schedules, including twice-monthly and monthly tablets, for more flexibility

  • Explicitly approved to prevent, not just treat, glucocorticoid-induced osteoporosis

Cons

  • Costs roughly $340 to $483 per month, substantially more than generic Fosamax

  • Not available as an oral solution, only as tablets

  • FDA-approved in 1998, giving it a somewhat shorter track record than Fosamax

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