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

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

Forteo

Most common
pain (up to 21.3%)
arthralgia (up to 10.1%)
asthenia (up to 8.7%)
nausea (up to 8.5%)

Fosamax vs. Forteo 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

Forteo

Dosage
Dosage Table
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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