Are there alternatives to Fosamax?

Fosamax is a prescription medication that helps prevent and treat osteoporosis. It’s a brand-name medication containing the active ingredient alendronate. Alendronate is an effective drug for osteoporosis and other bone conditions.

Fosamax can have adverse effects, such as diarrhea, chest pain, and risk of fractures, and to avoid these, you may consider alternatives.

Alternatives to Fosamax include other medications and treatment options, and we’ll look at some of these here.

Osteoporosis medications

Osteoporosis affects about 10 million people over 50 in the United States. Most of them are female, but 2 million are male.

Osteoporosis causes loss of bone density. Your doctor may prescribe medications to help manage the condition.

The first-line treatment for osteoporosis typically includes bisphosphonates, like:

• alendronate (Fosamax)
• ibandronate (Boniva)
• risedronate (Actonel)
• zoledronic acid (Reclast)

Bisphosphonates help maintain bone density by slowing the speed at which your bones deteriorate. They can come as oral weekly or monthly tablets, an injection, or in liquid form. It can take 6–12 months for bisphosphonates to work. 

Your doctor may also suggest you take vitamin D and calcium supplements.

However, healthcare professionals will not recommend or prescribe bisphosphonates if you:

• are hypersensitive to bisphosphonates
• have hypocalcemia or low calcium levels
• have chronic kidney disease 
• have esophageal disorders

Your healthcare team may consider other medications and treatment options in these cases.  

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What are some alternative Fosamax medications?

Besides bisphosphonates, other osteoporosis medications include hormone-like medications and biological medicines or antibodies.

Hormone-like medications

These medications have effects similar to hormones and include:

• Calcitonin salmon (Miacalcin): This drug helps control calcium levels in your blood, and you can take it by injection or nasal spray.
• Raloxifene (Evista): This medication is a selective estrogen receptor modulator (SERM). SERMs work by maintaining bone density and reducing the risk of fractures, similar to estrogen. This is a SERM that’s taken as a tablet once per day. 
• Parathyroid hormones (PTHs): There are two types of PTHs, teriparatide (Forteo) and abaloparatide (Tymlos), both injectable. The drugs control the body’s calcium and phosphate levels and help stimulate cells to produce new bone.

Biological medications or antibodies

Biological medications may best suit people with osteoporosis who can’t take bisphosphonates. They contain proteins and other substances the body produces. They include:

• Denosumab (Prolia): This drug reduces bone breakdown and helps maintain bone density. It is an injectable medication that you will usually take every 6 months.
• Romosozumab (Evenity): This drug helps strengthen your bones. You can take this medication as an injection once each month for 12 months. 

What are the side effects of osteoporosis medication?

You may sometimes experience side effects with osteoporosis medications, some similar to menopause and osteoporosis symptoms.

SERM side effects include:

• hot flashes
• leg cramping
• increased vaginal discharge
• irregular menstruation (periods)

Side effects of bisphosphonates and biological medications include:

• flu-like symptoms
• hypocalcemia
• esophageal irritation
• bowel movement changes
• jaw symptoms
• tiredness
• joint and bone pain

Bisphosphonates can also lead to a rare, serious side effect known as osteonecrosis of the jaw, in which you can lose part of your jaw bone.

Talk with your doctor if you experience any adverse effects from your osteoporosis medications. 

Dosages 

When prescribing osteoporosis medication, your doctor will consider:

• your age
• your sex
• whether you’re menopausal or postmenopausal
• the cause of the bone loss, such as due to menopause or prostate cancer treatment
• your fracture risk

To begin, your doctor will typically prescribe the lowest dose of medication. The following dosages are for treating osteoporosis and bone loss.

Calcitonin

Nasal spray, 200 International Units (IU), once daily, alternating nostrils each day

100 IU subcutaneous injection once daily

SERMs

Raloxifene (Evista), 60-milligram (mg) tablet, once daily.

Parathyroid hormones (PTHs)

Teriparatide (Forteo), 20-microgram (mcg) subcutaneous injection once daily

Abaloparatide (Tymlos) 80-mcg subcutaneous injection once daily

Denosumab (Prolia)

60-mg subcutaneous injections every 6 months.

Romosozumab (Evenity)

Two separate 105-mg subcutaneous injections, totaling 210 mg, monthly for 12 months.

Is there a dosage difference for males and females?

The dosage for men and women to treat osteoporosis and bone loss can be the same. However, dosages can also vary depending on the condition. For example, calcitonin can also treat conditions like Paget’s disease, which may mean a different dosage.

Alternative treatments for osteoporosis

Apart from medication, your doctor may consider other treatments or suggest lifestyle strategies to help you manage osteoporosis. These include:

• hormone replacement therapy (HRT)
• calcium and vitamin D supplements
• vibration therapy
• weight-bearing exercises 
• physical therapy
• quitting smoking
• reduced alcohol and caffeine consumption
• a balanced diet

Summary

Fosamax, the brand-name version of alendronate, is a prescription medication a doctor may prescribe to help you treat and manage osteoporosis. The active ingredient, alendronate, belongs to a class of drugs known as bisphosphonates and is usually the first-line treatment for people with osteoporosis.

Fosamax and other bisphosphonates may not suit everyone. If you can’t take Fosamax or other bisphosphonates to treat osteoporosis, hormone-like medications, and antibodies are available. Besides medications, you may also consider hormone replacement therapy (HRT), physical therapy, and lifestyle strategies.

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