Anonymous Posts: n/a Re: Boniva vs. Fosamax vs. Actonel -------------------------------------------------------------------------------- OK, let me straighten everyone out... Oral bisphosphonates (boniva, fosamax, actonel) are all extremely similar. Their ONLY function is to inhibit bone loss. This allows the body to then have a better balance on bone remodeling, which means it can naturally build bone, therefore improving bone health. Good bone health is what reduces fractures, & is dependent on much more than the drugs. You must have good levels of calcium & vitamin D as well, otherwise, the drugs will be of little benefit. Which is the best? The one each patient is most compliant with! We do know, however, that bisphosphonates are literally toxic to the esphogeal lining. This is why less exposure (less dosing) is safer, so my vote is clealy with once-monthly boniva. They all have similar numbers of pivotal trials. "Long term data" means nothing more than the length of time the drugs have been on the market. All have been on long enough to prove they are safe & effective. (Fosamax may be the most prescribed, but that's only because it has been on the market the longest, their company gives the highest rebates to the managed care companies, and because most doctors form habits & don't have osteoporosis high enough on their radar screen to care enough about changing their habits. Sad, I know). From a pure numbers perspective, fosamax & boniva are the best. Fosmax conducted a head-to-head trial with actonel & was proved statistically superior over actonel. Then, boniva conducted a head-to-head with fosamax & proved statistically equivalent to fosamax. Actonel is a good bisphosphonate, it's just that the mg strength is too low. Sorry actonel, the truth hurts. Regarding nonvertebral fracture reduction...it's all VERY inconsistent & NOT required by the FDA for approval. Osteoporosis shows up first in the spine, therefore, the FDA requires drugs to prove efficacy in the spine ONLY. Fosamax was the only one to prove hip fracture reduction, but only by 1 fracture in 1 trial. In their other pivotal trial, they could not prove statistical significance. Actonel showed nonvertebral reductions in 1 trial, though not statistically significant hip data, and could not show nonvert in their 2nd trial. Boniva could not prove nonvert, but had a healthy patient population - they were not osteoporotic at the hip, so how do you show fracture protection when you're not at risk for fracture?) Even Forteo, strongly considered to be the best agent for osteoporosis therapy, could NOT show statistically significant hip fracture reduction!!!! Besides, all of the "fracture data" lies within the trials from the "daily doses" which are no longer used. The FDA allowed "bridging" studies based on bone mineral density ONLY, to prove "non-inferiority" to the new extended dose versions. So, fracture reduction cannot be claimed on the extended dose oral bisphosphonates, only implied fracture protection through improved bone health. Regarding IV bisphosphonates, reclast has best in class data, but also has significant safety issues. Boniva has an IV injection, which also has good bisphosphonate data, but with much fewer safety concerns, most importantly, NO cardiovascular side effects. So, to the 74 yo willing to accept possible arrhythmias...you don't have to worry about this with boniva injection. Did you have cardio issues before starting reclast? If you're "specialist" didn't give you boniva injection as an option, I would suggest getting a new specialist & then contacting a good lawyer if you develop cardio issues! Hope this clears things up out there! Dr Anonymous _______________________________________________________________ Check your data again. To say that the data backing Fosamax or Boniva is better than Actonel's data shows just how misguided you are about the facts. The first head-to-head trial, the so-called "FACT" trial was nothing more than a BMD study w/fractures measured only as a side affect. Guess what; there were more fractures in the alendronate group than the risedronate group. The second "FACT" trial was also a BMD study, only this time they set it up so that the side affect fracture total was fairly equal. Drugs that are supposed to prevent patients from fracturing should have FRACTURE PREVENTION as their primary endpoint, not some surrogate marker. Fosamax origionally had a wrist fracture indication but had it pulled because of lack of efficacy proved in FRACTURE PREVENTION. Then it gets even better. There have been studies showing that there are indeed differences among the bisphosphonates w/regard to the amount of time that the various drugs "stick to the bone". Some come off the bone quicker than others and spread to different sites compared to others. Their are also difference among the drugs concerning their affinity for certain receptors in the osteoclast and their ability to cause apoptosis. Check the headlines for current articles on long bone fractures w/Fosamax. Word is that Paul Miller, MD is close to publishing an article connecting long term (over five year) usage of alendronate(Fosamax) and non-traumatic radial fractures in the femurs of osteoporosis patients. Literature also has one case so far of this happening already in a Reclast patient. Who would take Boniva when it has much less data on protecting against non-vertebral fractures (including HIP), patients have to wait an extra half hour before eating breakfast, it generally has a higher co-pay and the pill itself is twice as big as the 150mg OAM Actonel? Their are differences. Really clearing things up.