Fosamax vs. Forteo
See how Fosamax and Forteo compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Fosamax is an oral bisphosphonate that slows bone breakdown, while Forteo is a daily injection that stimulates new bone formation.
Fosamax is a low-cost generic tablet, while Forteo is a far more expensive daily self-injection usually reserved for higher fracture risk.
Both drugs treat osteoporosis but work through different mechanisms, so a doctor may choose one over the other based on fracture risk and prior treatment response.
Fosamax vs. Forteo Drug Summary
Fosamax
Fosamax (alendronate) is an oral bisphosphonate that slows the breakdown of bone to help maintain or increase bone density. It's approved for osteoporosis treatment and prevention in postmenopausal women, for men with osteoporosis, and for glucocorticoid-induced osteoporosis and Paget's disease. It's taken as a tablet once daily or once weekly, first thing in the morning on an empty stomach.
Forteo
Forteo (teriparatide) is a parathyroid hormone analog that works differently from most osteoporosis drugs by directly stimulating new bone formation instead of just slowing bone loss. It's approved for postmenopausal women, men with primary or hypogonadal osteoporosis, and glucocorticoid-induced osteoporosis, all in patients at high fracture risk. It's given as a once-daily subcutaneous injection using a prefilled pen.
Fosamax vs. Forteo Side Effects
Fosamax
Forteo
Fosamax vs. Forteo Dosage
Fosamax
Forteo
| 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 | 20 mcg once daily | At the start |
| Maximum dose | 20 mcg once daily | Same as starting |
| Dose changes | None | Fixed dose |
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 |
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 |
Fosamax vs. Forteo 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 glucocorticoid-induced osteoporosis and Paget's disease of bone. It's one of the most widely prescribed bisphosphonates because of its long track record and broad approval across different patient groups.
Treatment of osteoporosis in postmenopausal women
Prevention of osteoporosis in postmenopausal women
Increasing bone mass in men with osteoporosis
Forteo
Forteo is FDA-approved for postmenopausal women and men with osteoporosis who are at high risk of fracture, as well as for glucocorticoid-induced osteoporosis in high-risk patients. It's typically reserved for patients with more severe bone loss or those who haven't responded well to other treatments.
Postmenopausal osteoporosis, high fracture risk
Osteoporosis in men, high fracture risk
Glucocorticoid-induced osteoporosis, high risk
Fosamax vs. Forteo Pros and Cons
Fosamax
Fosamax has decades of safety data and is available as an inexpensive generic tablet, making it a common first-line choice for osteoporosis. It does require strict dosing instructions to avoid esophageal irritation, and long-term use carries small risks like atypical femoral fractures.
Pros
Oral tablet, no injections needed
Decades of long-term safety data
Roughly $166 to $210 per month without insurance, far less than Forteo
Cons
Must remain upright after each dose
Risk of esophageal irritation or ulcers
Long-term use linked to atypical fractures
Not recommended for severe kidney impairment
Forteo
Forteo directly builds new bone rather than just slowing its breakdown, which can make it useful for patients with severe osteoporosis or prior fractures. It requires a daily injection and costs significantly more than oral options, and its 2021 label update removed the boxed osteosarcoma warning after long-term data showed no added human risk.
Pros
Builds new bone instead of just slowing loss
Boxed osteosarcoma warning removed in 2021
Option when bisphosphonates aren't tolerated
Cons
Requires a daily self-injection
Risk of hypercalcemia and calcification
Transient dizziness with initial doses
Roughly $4,590 to $5,100 per month without insurance, far more than Fosamax
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