Picking the Right Osteoporosis Medicine for You
Here are 6 types of osteoporosis medicine to consider.
No. 1: Bisphosphonates: Fosamax, Actonel, Boniva, Zoledronic Acid (Reclast or Zometa) continued...
Also, for patients who don't have a pharmacy benefits plan -- with their insurance or with Medicare -- intravenous Reclast or Boniva may be the better option, says Tanner. "Because it's done at the physician's office, it will be covered." However, you must meet your insurance deductible and co-pay.
Generic Fosamax: If you are a good candidate for pill form, Fosamax is now available in a cheaper, generic form. It's a good option if finances are a problem, Tanner says. "Some people can't afford more than $4 a month." It's important to know, however, that generics are required to be 80% equivalent to the brand medicine, and may not be 100% identical, she tells WebMD. "For a medication that is so difficult for the body to absorb, I think that's a risk."
Possible side effects: These osteoporosis medicines can upset the stomach, causing heartburn for a day or two. "Actonel seems to cause a bit less GI side effects," says Ruppe.
Some patients report muscle and joint pain with these osteoporosis treatments, but only rarely is it a serious problem. "It's not a reason to stay away from the medication," Tanner says.
However, the side effects are the main reason people quit their osteoporosis medicine, Ruppe tells WebMD. That's when the bone resorption marker test can help. "It can show the effect of medication, whether it's working. Somebody who needs reassurance needs this. It's positive reinforcement to keep taking the medication."
Because Reclast is given once-yearly in treating osteoporosis, some patients are nervous about side effects -- whether they will last a whole year, says Tanner. "About 20% get a flu-like illness the first few days afterwards. A very rare event is bone pain that may go on for awhile. But less than 1% get that. It's pretty rare." Treatment with ibuprofen (such as Advil, Motrin) or acetaminophen (such as Tylenol) helps improve the symptoms.
Considering the risks: Atrial fibrillation (abnormal heart rhythms) has been a concern. A large study showed that some patients treated with Zoledronic acid (Reclast or Zometa)had more abnormal heart rhythms than those treated with placebo. Other follow-up studies did not show this effect. The FDA has advised that patients should not stop taking bisphosphonates -- but to report side effects and symptoms to their doctors.
There is also slight risk of osteonecrosis of the jaw, which can cause pain, swelling, exposed bone, local infection, and fracture of the jaw. But osteonecrosis is rare and has been seen in patients who have had chemotherapy or radiation therapy and are receiving long-term bisphosphonate therapy, says Tanner. "It's extremely rare," he tells WebMD. "The benefit of preventing bone fractures far outweighs the risk of osteonecrosis of the jaw."
Thacker agrees: "The risk of osteonecrosis of the jaw is overexaggerated. The Horizon Trial studied Reclast in 8,000 postmenopausal women and found no increase in osteonecrosis of the jaw."