Fosamax vs. Evenity
See how Fosamax and Evenity compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Fosamax is a daily or weekly pill, while Evenity is a once-monthly injection limited to 12 doses in a lifetime.
Evenity carries a boxed warning for heart attack, stroke, and cardiovascular death, while Fosamax's main risks involve the esophagus and jaw.
Fosamax costs far less out of pocket than Evenity, which usually requires switching to another osteoporosis drug afterward to hold onto bone gains.
Fosamax vs. Evenity Drug Summary
Fosamax
Fosamax (alendronate) is a bisphosphonate that slows bone breakdown to treat and prevent osteoporosis in postmenopausal women, treat osteoporosis in men, and manage glucocorticoid-induced osteoporosis and Paget's disease. It comes as a tablet taken once daily or once weekly, on an empty stomach with plain water, staying upright afterward.
Evenity
Evenity (romosozumab-aqqg) is a sclerostin inhibitor that both builds new bone and slows bone loss, approved for postmenopausal women with osteoporosis at high risk of fracture. It's given as two subcutaneous injections once a month, for a maximum of 12 doses in a lifetime, followed by another therapy to maintain the bone gained.
Fosamax vs. Evenity Side Effects
Fosamax
Evenity
Fosamax vs. Evenity Dosage
Fosamax
Evenity
| STAGE | DOSE | WHEN |
| Starting dose | 40 mg once daily | At the start |
| Maximum dose | 40 mg once daily | Same as starting |
| Dose changes | None | Fixed dose |
| STAGE | DOSE | WHEN |
| Starting dose | 210 mg once monthly | At the start |
| Maximum dose | 210 mg once monthly | Same as starting |
| Dose changes | None | Fixed dose |
Fosamax
| STAGE | DOSE | WHEN |
| Starting dose | 40 mg once daily | At the start |
| Maximum dose | 40 mg once daily | Same as starting |
| Dose changes | None | Fixed dose |
Evenity
| STAGE | DOSE | WHEN |
| Starting dose | 210 mg once monthly | At the start |
| Maximum dose | 210 mg once monthly | Same as starting |
| Dose changes | None | Fixed dose |
Fosamax vs. Evenity Indications
Fosamax
Fosamax is FDA-approved for several bone conditions beyond routine postmenopausal osteoporosis. It can be used in men, in people on long-term steroids, and for Paget's disease of bone, giving it a broader label than many newer osteoporosis drugs.
Treatment of osteoporosis in postmenopausal women
Prevention of osteoporosis in postmenopausal women
Increasing bone mass in men with osteoporosis
Glucocorticoid-induced osteoporosis
Evenity
Evenity's approval is narrower, covering only postmenopausal women with osteoporosis who are at high risk for fracture. It is not approved for men, premenopausal women, or women of reproductive potential, largely due to safety concerns.
Postmenopausal women with osteoporosis at high fracture risk
History of osteoporotic fracture
Multiple risk factors for fracture
Not approved for men or premenopausal women
Fosamax vs. Evenity Pros and Cons
Fosamax
Fosamax has decades of real-world safety data, a low-cost generic option, and flexible daily or weekly dosing, but it requires strict administration rules to avoid esophageal irritation. It also is not appropriate for people with severe kidney impairment or uncorrected low calcium.
Pros
Available as a low-cost generic tablet
Decades of long-term safety data
Flexible daily or weekly dosing options
Cons
Must be taken on an empty stomach with plain water
Requires staying upright for 30+ minutes after dosing
Not approved for severe renal impairment
Long-term use linked to atypical femoral fractures
Evenity
Evenity offers a unique dual action that builds new bone while also reducing bone breakdown, but its cardiovascular boxed warning limits who can safely use it. Treatment is capped at 12 lifetime doses and costs substantially more than oral options like Fosamax.
Pros
Builds new bone instead of only slowing loss
Only one injection visit needed per month
Option for patients at very high fracture risk
Cons
Boxed warning for heart attack, stroke, and death
Cannot be started within a year of MI or stroke
Limited to 12 doses in a lifetime
Roughly $1,825 to $2,629 per month without insurance, before savings programs
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