Pricey osteoporosis remedy doesn't beat older drugs

Osteoporosis drugs are big sellers, bringing in some $2 billion in 2008 alone. Now one of the newest of those drugs, ibandronate, also known as Boniva, has scored major (and no doubt expensive) marketing points by having actress Sally Field as its spokeswoman.

In a Boniva television commercial, Field discusses how the drug helped her reverse her own osteoporosis-caused bone loss. She also touches upon Boniva's main advantage: It can be taken monthly instead of daily or weekly. It was the first drug in its class—called bisphosphonates—with this oral dosage. You have to take a daily or weekly bisphosphonate on an empty stomach and stay upright for 30 minutes; with Boniva, the wait is an hour, but you take it only once a month.

What the ad fails to mention is that Boniva costs about 10 times as much as generic alendronate; the brand name is Fosamax. And as great as the commercial makes it sound, studies don't show that Boniva is any more effective at preventing bone fractures—the goal of a drug designed to treat osteoporosis—than alendronate, risedronate (Actonel), or other bisphosphonates. For that reason, Consumer Reports currently rates Boniva somewhat lower than the older bisphosphonates. If you can spare the half-hour a week, try generic alendronate first, since it costs less.

Doctors prescribe bisphosphonates not just for osteoporosis but also for osteopenia, or "pre-osteoporosis." It's less clear that the drugs are effective for that. Bisphosphonates do come with risks, including jawbone damage, eye inflammation, and serious muscle, bone, and joint pain. Our medical consultants recommend these steps:

• If bone-density testing reveals you have osteoporosis, consider a bisphosphonate, preferably generic alendronate.
• If you've taken a bisphosphonate for five or more years, ask your doctor about stopping temporarily to encourage normal bone remodeling and reduce the risk of side effects.
• For osteopenia, consider a bisphosphonate only if your bone density worsens. Otherwise, focus on strengthening bones by consuming up to 1,500 milligrams of calcium and 1,000 international units of vitamin D daily. Try doing weight-bearing exercise and resistance training at least twice a week.