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
Actonel
Fosamax vs. Actonel Dosage
Fosamax
Actonel
| 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 |
| 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
| 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
| 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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