Fosamax vs Forteo

Listen to the article instead of reading through it.

0:00

Introduction

For patients with osteoporosis or other conditions causing bone loss, certain drugs that alter the process of bone regeneration and resorption can help in enhancing bone strength and reducing the risk of fractures. Fosamax (Alendronate) and Forteo (Teriparatide) are two such drugs prescribed for osteoporosis. They each have unique ways to handle this condition but both aim to enhance overall bone health.

Fosamax is a bisphosphonate which functions by slowing down the rate at which your body breaks down bones, thus it's more about preventing further loss than building new tissue. On the contrary, Forteo belongs to a class of drug called parathyroid hormone analogs; it works differently by stimulating new bone growth, increasing density and strength.

While comparing these two medications based on their mechanisms alone may seem like one simply prevents while another enhances growth, it's vital to consider patient-specific factors including age, gender, severity of condition along with possible side-effects before making an informed choice for treatment.

What is Fosamax?

Alendronate (the generic name for Fosamax) was one of the first drugs in the class of bisphosphonates used to treat osteoporosis, which marked a significant advancement from earlier calcium and vitamin D supplements. Alendronate was first approved by the FDA in 1995. Fosamax works by slowing bone loss, helping maintain existing bone mass and reduce the risk of fractures. It is typically prescribed for postmenopausal women or individuals with other conditions that lead to bone loss.

On the other hand, Teriparatide (the generic name for Forteo) is a recombinant form of parathyroid hormone, which actually stimulates new bone growth - quite different from how Fosamax works. Approved by the FDA in 2002, it's usually prescribed when other treatments haven't worked or aren't appropriate.

While both are effective at reducing fracture risks associated with osteoporosis, they work differently – one slows down bone loss while the other promotes new growth – and thus have different side effects profiles.

What conditions is Fosamax approved to treat?

Fosamax and Forteo are both approved for the treatment of specific bone conditions:

Osteoporosis in postmenopausal women
To increase bone mass in men with osteoporosis
Treatment to increase bone mass in women and men at high risk for fracture receiving ongoing systemic glucocorticoid therapy. However, Forteo is often recommended when other available osteoporosis treatments are not suitable or have been ineffective.

How does Fosamax help with these illnesses?

Fosamax helps to manage osteoporosis by slowing down the process of bone breakdown. It achieves this by inhibiting the action of osteoclasts, cells that break down bone tissue, allowing for a better balance between bone formation and resorption. This means more calcium stays in the bones, making them stronger and less prone to fractures. On the other hand, Forteo works differently; it stimulates new bone growth by mimicking parathyroid hormone (PTH), a naturally occurring hormone that regulates calcium metabolism in the body. By increasing PTH levels temporarily each day, Forteo encourages more new bone formation than resorption overall, leading to an increase in bone density and strength over time. Both Fosamax and Forteo work on different aspects of managing osteoporosis with distinct mechanisms but are aimed towards one goal: preventing fragility fractures.

What is Forteo?

Forteo, also known by its generic name teriparatide, is a recombinant form of parathyroid hormone. It works differently from bisphosphonates like Fosamax (alendronate) because it actually stimulates the body to produce more bone rather than merely preventing the breakdown of existing bone. Forteo was first approved by the FDA in 2002 specifically for use in postmenopausal women with osteoporosis who are at high risk for fractures. Unlike alendronate which slows down the process of bone resorption carried out by cells called osteoclasts, teriparatide boosts new bone formation through its action on another type of cell called an osteoblast. This difference means that Forteo can sometimes lead to greater increases in bone density compared to Fosamax and other drugs in its class. However, it comes with a different side-effect profile as well, including potential risks such as orthostatic hypotension and hypercalcemia (high calcium levels), although serious side effects are not common.

What conditions is Forteo approved to treat?

Forteo is FDA-approved for the treatment of certain specific conditions:

Osteoporosis in postmenopausal women who are at high risk for fracture.
To increase bone mass in men with primary or hypogonadal osteoporosis who are at high risk for fracture.

It's also approved to treat both men and women with osteoporosis due to use of glucocorticoids, a type of medication that can lead to bone loss.

How does Forteo help with these illnesses?

Parathyroid hormone (PTH) is a critical regulator of calcium and phosphate homeostasis in the body, playing significant roles in bone remodeling. A decrease in blood calcium levels triggers the release of PTH, leading to increased osteoclast activity which releases stored calcium from bones back into the bloodstream. Forteo, also known as teriparatide and a form of parathyroid hormone therapy, works by stimulating new bone growth. This makes it particularly effective for individuals with severe osteoporosis or those at high risk of fractures. Its unique action on bone formation sets it apart from other medications such as Fosamax which primarily slow down bone loss without actively promoting new bone growth. While both drugs have their place in managing osteoporosis, one might consider Forteo when there's an immediate need for improving bone density or if patients do not respond well to other treatments like bisphosphonates including Fosamax.

How effective are both Fosamax and Forteo?

Both alendronate (Fosamax) and teriparatide (Forteo) have established histories of success in treating patients with osteoporosis, and they were initially approved by the FDA within several years of each other. Since they act on different biological pathways related to bone metabolism, Fosamax and Forteo may be prescribed under different circumstances. The effectiveness of Fosamax and Forteo was directly studied in a double-blind clinical trial in 2003; both drugs exhibited efficacy in increasing bone mineral density as well as promising safety profiles.

In a 2011 meta-analysis report on alendronate, it showed that it is effective at reducing fracture incidence starting from the first year of treatment. Its side effect profile is generally favorable over many other bisphosphonates, being well-tolerated even among elderly populations. This study also reports that Fosamax has become one of the most widely-prescribed drugs for osteoporosis globally.

A 2020 review indicated that teriparatide seems to be more effective than placebo at increasing bone mineral density and reducing fracture risk. Nonetheless, due to its higher cost relative to bisphosphonates like alendronate, teriparatide is typically considered a second-line treatment option, meaning it's generally considered only after other first-line treatments have failed or are contraindicated. Further research into its use involves co-prescription alongside antiresorptive agents like bisphosphonates or denosumab.

abstract image of a researcher studying a bottle of drug.

At what dose is Fosamax typically prescribed?

Oral dosages of Fosamax range from 5–70 mg/day depending on the condition being treated, with studies indicating that 10 mg/day is typically effective for preventing postmenopausal osteoporosis. Forteo, in contrast, is administered via daily subcutaneous injection at a consistent dose of 20 mcg/day for treating osteoporosis in men and postmenopausal women who are at high risk for fracture. In either population using these medications, dosage adjustments may be considered based on individual response and tolerability after consultation with a healthcare provider. The maximum duration for using Forteo should not exceed 2 years due to its potential bone cancer risk.

Find Top Clinical Trials

Choose from over 30,000 active clinical trials.

At what dose is Forteo typically prescribed?

Forteo treatment is initially administered at a dosage of 20 mcg/day, delivered subcutaneously (under the skin). Unlike some other medications, there's no need to increase this dose over time. The medication comes in a pre-filled pen that delivers doses of 20 mcg with each injection. It should be injected once every day into the thigh or abdomen as directed by your healthcare provider. This daily regimen continues for up to 24 months; Forteo has not been tested beyond two years of therapy. If after this period there are still concerns about bone density or fracture risk, your physician may consider other treatments.

What are the most common side effects for Fosamax?

Common side effects that people using Fosamax may experience include:

Acid reflux or heartburn
Nausea, vomiting, bloating
Constipation or diarrhea
Joint pain or swelling
Dizziness
Headache

On the other hand, Forteo users might encounter different side effects such as:

Pain at the injection site
Leg cramps
Dizziness and fainting (especially when getting up from a sitting or lying position) -Nausea -Decreased appetite.

Remember, it is essential to contact your healthcare provider if you notice any of these symptoms after starting medication.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Fosamax?

While both Fosamax and Forteo are used to treat osteoporosis, they can have different side effects. For Fosamax, in rare cases:

Serious skin reactions may occur: hives, difficulty breathing, swelling in your face or throat
Abnormal bone fractures in the thigh
Severe joint, bone or muscle pain
Jaw-bone problems (osteonecrosis), including severe jaw pain and tooth loss
Unusual hip/thigh/groin pain which could be indicative of a possible fracture.

For Forteo however:

Fast or pounding heartbeats; dizziness when getting up from a sitting/lying position.
Signs of an allergic reaction such as rash; hives; itching; red, swollen skin; blisters on the skin that may crack open and bleed.

Remember that these side effects are relatively rare. If you experience any unusual symptoms while taking either medication, reach out to your healthcare provider immediately for guidance.

What are the most common side effects for Forteo?

Forteo, compared to Fosamax, has its own set of potential side effects that users should be aware of:

Nausea or vomiting
Fast heartbeat
Dizziness upon standing up quickly due to low blood pressure (orthostatic hypotension)
General weakness or feeling tired
Joint aches and muscle spasms
Leg cramps or pain in the legs and arms
Mild skin rash at the injection site Aside from these physical symptoms, you might also experience changes in your mood such as confusion and depression. Always consult your doctor if any of these symptoms persist or become bothersome.

Are there any potential serious side effects for Forteo?

While Forteo is generally safe, it's important to be aware of potential side effects that might require immediate medical attention. These can include:

Signs of an allergic reaction: rash, itching or hives on the skin; shortness of breath, wheezing or difficulty breathing; swelling of the face, lips, tongue or other parts of the body
New or worsening heart palpitations (fast and irregular heartbeats)
Nausea and/or vomiting
Confusion
Muscle weakness
Unusual tiredness.

Forteo has also been associated with a risk for osteosarcoma in animal studies. This is a rare type of bone cancer which may appear as bone pain that isn’t related to daily activities or injuries.

Remember: if you experience these symptoms while taking Forteo, contact your healthcare provider right away.

Contraindications for Fosamax and Forteo?

Both Fosamax and Forteo, along with many other drugs for osteoporosis, may cause side effects in some people. If you notice a worsening of your symptoms or experience severe pain in the bones, joints or muscles, please seek immediate medical attention.

Neither Fosamax nor Forteo should be taken if you have certain conditions such as high levels of calcium in your blood (hypercalcemia), bone cancers or metabolic bone diseases. Always inform your physician about any health issues you are experiencing; these conditions could lead to dangerous interactions with Fosamax and Forteo.

If you're taking medications like digoxin which can interact adversely with Fosamax and Forteo by increasing the level of calcium inside your body, it's crucial to discuss this with your doctor. It might require monitoring or adjusting the dose of that medication when initiating treatment with either Fosamax or Forteo.

How much do Fosamax and Forteo cost?

For the brand name versions of these drugs:

The price for 4 tablets (70mg each) of Fosamax averages around $130, which works out to approximately $32.50 per week or just over $4.60 per day.
In contrast, one Forteo pen injector (600 mcg/2.4 ml), providing a 28-day supply at the recommended daily dosage costs about $3,200. This is roughly equivalent to an exorbitant cost of about $114/day.

Hence, if you are considering cost alone, brand-name Fosamax is significantly less expensive on a per-day treatment basis compared to Forteo.

However, for generic versions of these medications:

Alendronate Sodium (generic form of Fosamax) costs slightly lower with prices ranging from as low as under $1 up to about $2 per pill depending on your location and place of purchase.

Unfortunately there's currently no FDA-approved generic version available for Forteo in United States market so comparison cannot be made on that front. It's crucial however not let cost be your primary consideration when determining what medication is right for you; effectiveness and potential side effects should also factor into your decision-making process.

Popularity of Fosamax and Forteo

Alendronate, also known under the brand name Fosamax, was estimated to have been prescribed to about 3.7 million people in the US in 2020. Alendronate accounted for just over 42% of bisphosphonates prescriptions in the US. It is classified as a first-line treatment for osteoporosis hence its popularity among patients and physicians alike.

On the other hand, Teriparatide, sold under brand names such as Forteo, was prescribed to approximately 400 thousand people in USA during the same year. The prevalence of teriparatide accounts for around 12% of parathyroid hormone analogue prescriptions and considerably less when considering overall osteoporosis drug prescriptions due to its use being typically reserved for severe cases or those where other treatments have failed or are contraindicated. While both drugs are used in treating osteoporosis, they work via different mechanisms with alendronate slowing bone loss while teriparatide stimulates new bone growth.

Conclusion

Both Fosamax (alendronate) and Forteo (teriparatide) have well-established records of usage in patients with osteoporosis, and are backed by numerous clinical studies indicating that they are effective for increasing bone density and reducing the risk of fractures. In some cases, these drugs might be used sequentially but rarely together, due to their opposing mechanisms of action. Fosamax works primarily by decreasing bone resorption, slowing down the process where old bone is broken down so new bone can be built more effectively. On the other hand, Forteo works differently as it increases the creation of new bone.

Fosamax is often considered a first-line treatment option for most people because it's generally safe and has been available as an inexpensive generic medication for many years now. On the contrary, Forteo is usually prescribed when patients haven't responded well to bisphosphonates like Fosamax or if they're at very high risk for fractures.

The side effect profile between these two medications does differ somewhat: both drugs may cause nausea or pain in your arms or legs. However, only Fosamax might cause heartburn or irritation in your esophagus if not taken properly; while rare but serious side effects like leg cramps and dizziness occur only with Forteo use. For both drugs, patients should closely monitor their responses after starting treatment and seek medical help immediately if they notice any severe reactions such as difficulty swallowing/breathing/chest pain (Fosamax) or fast heartbeat/feeling faint/unusual tiredness (Forteo).