The first drug on the market was Fosamax, follow by Actonel a few years later, then Boniva. Fosamax and Actonel are both taken weekly, while Boniva is taken monthly orally, and every three months intravenously. If taking medication is hard for you to remember or a hassle for you to keep up with, Boniva would be a good option.

Another thing to keep in mind is that after taking any of the medications, you must be on your feet for a period of time. Both Fosamax and Actonel, you must be standing for 30 minutes, where as Boniva requires you to be standing up for an hour. If you have a hard time staying on your feet for an extended period of time, you may want to consider Fosamax or Actonel.

All three drugs have FDA approval for the treatment and prevention of post-menopausal osteoporosis. Actonel has approval to reduce fractures at vertebral and nonvertebral sites (hip, wrist, pelvis, clavicle, leg, humorous), Fosamax at vertebral and hip, while Boniva has approval for the spine only.

Since there has been no clinical studies directly comparing all of the drugs, it is hard to say which one is statistically the best. All have been proven affective at treating osteoperosis, so I would talk it over with your doctor and weigh out the benefits of each before making a decision.

Earlier this month, a closely-watched trial over the osteoporosis drug Fosamax ended in mistrial, to the frustration of nearly everyone involved. The trial was marked by great tension, with a deadlocked jury, reports of threats of physical violence, and a judge-ordered cooling-down period.

What could cause such intense drama? Well, this was just one of approximately 900 state and federal cases pending against Fosamax, alleging that that medication causes osteonecrosis of the jaw (the death of jawbone tissue). In large part, the tension in the Manhattan courtroom was that this trial — the first — was supposed to be an indicator of how these hundreds of similar cases might proceed. The other major factor is that it is notoriously difficult to “prove” drug-related injuries, and this difficulty was definitely shown in the frustration and tension among jury members.

Millions of women have taken Fosamax (alendronate), a Merck drug that was approved in 1995 to treat osteoporosis associated with menopause, and in 1997 to prevent osteoporosis itself. Until the recent introduction of some competing medications, it was one of the most popular drugs in the U.S. It is still prescribed millions of times per year to women suffering from bone loss.

In short, Merck’s defense on this topic is that there is no definitive evidence that Fosamax causes the death of jaw tissue, while plaintiffs and their lawyers insist that Merck overpromoted Fosamax without warning doctors about the potential for jaw injury. Obviously, no conclusions were reached.

Of course, this is of great interest to women who may have taken, or are considering taking, Fosamax. Only your doctor can decide what is the right choice for you, but we thought we would enumerate the other medications available for treating osteoporosis for those doing research on Fosamax alternatives. One very important thing to be aware of it is that Fosamax is not the only osteoporosis drug in this class (the bisphosphonates), which all have a similar mode of action. Fosamax is being talked about most in the media, but all are associated with some amount of risk of damaging the jaw.

If you do choose to take a bisphophonate, know these facts:

• A high proportion of jaw injuries occur following high-dose intravenous administration, so that is a particularly risky way to take the medication.
• As many as 60% of the cases are preceded by a dental surgical procedure involving the jaw. In short, women who are expecting major dental work should consider delaying treatment with Fosamax, Boniva, Actonel or similar drugs until after their dental surgery.

Here are the main alternatives on the market for Fosamax:

1. Actonel (risedronate) is a bisphosphonate manufactured and marketed by Procter & Gamble and Sanofi-Aventis. It belongs to the same family of drugs as Fosamax, and may be associated with the same jaw side effects.
2. Boniva (ibandronate) is also a bisphosphonate, manufactured and marketed by GlaxoSmithKline and Roche Laboratories. It is a competitor to Fosamax, and may also affect the jaw tissue.
3. Evista (raloxifene) is NOT a bisphosphonate , but rather an oral selective estrogen receptor modulator from Eli Lilly and Company that affects bones through estrogen. Evista may be an interesting alternative for women concerned about their jaw health or planning oral surgery.

Also this month, The Wall Street Journal published an article called “From the Osteoporosis Front, Updates on Potential New Drugs.” These are the up-and-comers in clinical trials and going before the FDA. The story covers the latest news about Wyeth’s Viviant, Pfizer’s Fablyn, Amgen’s denosumab, and other upcoming treatments for osteoporosis.

If you are interested in following the Fosamax case that ended in a mistrial, it is expected to be re-tried in the spring. The name of the case is “In re Fosamax Products Liability Litigation, U.S. District Court, Southern District of New York (Manhattan), No. 06-1789.”

The drug commercials seem to me to be insulting. They overstate the benefits, minimize the side effects and ignore the cost: “Panacea is not for everyone,” they warn. “Let your doctor know if you have liver disease (he is too dumb to figure it out for himself) or are allergic to this drug (which you wouldn’t know in advance anyway). Side effects include fainting, jaundice, suicidal thoughts, constipation and sudden death. Do not operate heavy machinery after taking the first dose, and tell your doctor right away if you are dying”…

My favorite is Reclast, a once-a-year treatment for osteoporosis. It comes with many warnings, of course, including “jaw problems have been reported.” Jaw problems? What does that mean? Lock-jaw? Fossy-jaw? (I looked it up, and you don’t want to know while eating breakfast).

Reclast, like Fosamax and Boniva, is a treatment for osteoporosis, which refers to an extreme loss of bone density, most common in postmenopausal women. All three drugs are known as bisphosphonates.

The difference is that Reclast offers a level of convenience that the others don’t. Reclast is the first drug approved by the FDA (in 2007) as a once-a-year, intravenous treatment. As Novartis states on the Reclast Web site:

A single dose, along with daily calcium and vitamin D, helps strengthen your bones and protect them from fracture for 12 full months.

Reclast, along with Fosamax, Boniva and other bone-building drugs, have a number of side effects — but currently the FDA is most concerned about studies that show these drugs can produce irregular heartbeats in some patients. The most recent study, focusing on Fosamax, came out just last month.

Reclast’s jaw side effect, by the way, is osteonecrosis (“bone death”) of the jaw bone; it has occurred only in rare cases. Here’s a full list of Reclast warnings and precautions.

More on Reclast vs. Fosamax here.