Background

Osteoporosis is a condition in which the inside of bones becomes thin and less dense, weakening them and making them more likely to fracture. There are usually no symptoms of osteoporosis, so people can be unaware that they have the condition until they break a bone. The danger of osteoporosis is that it can lead to fractures of the hip, spine, and wrist, which can be permanently disabling. And fractures have other consequences: One in five women age 50 and older who break a hip will die in less than a year, according to the Agency for Healthcare Research and Quality.

More than 8 million women and 2 million men have osteoporosis, according to our analysis of figures from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Another 30 million men and women are at risk of developing osteoporosis due to low bone mass. Osteoporosis generally strikes older adults, beginning at around 50, with the highest prevalence seen in men and women over 80.

This report on drugs to prevent fractures in people with low bone density, or osteoporosis, is part of a Consumer Reports project to help you find safe, effective medication that gives you the most value for your health care dollar. To learn more about the project and other drugs we’ve evaluated, go to www.CRBestBuyDrugs.org.

Indications

Several types of medication are used to prevent fractures in people with osteoporosis, or "thinning" bones. They include brand-name and generic drugs, and they all pose a risk of side effects. Some are more effective at preventing certain types of fractures than others.

There’s little evidence that medication will help if you have osteopenia, sometimes called "pre-osteoporosis," which is bone density that’s lower than normal but not severe enough to be called osteoporosis. Instead of medication, consider lifestyle changes. That includes making sure that your diet has adequate amounts of calcium and vitamin D, and doing weight-bearing exercise, such as walking or lifting weights.

Also take precautions to prevent falls in the first place, such as limiting how much alcohol you drink and avoiding sleeping pills if possible. Consider medication only if your bone density worsens to the point where you have osteoporosis—although it’s still important to continue the lifestyle changes.

Our Recommendations

If your doctor diagnoses osteoporosis and recommends medication, we suggest the following Best Buy Drug after taking into account effectiveness, safety, convenience, and cost:

The drug is available as a generic that costs $39 to $63 a month depending on the dose. It has been shown to help prevent fractures of the hip, spine, and other bones in those with osteoporosis. It’s usually well-tolerated, but as with all bisphosphonates , the most common side effects include diarrhea, nausea, vomiting, heartburn, esophageal irritation, and bone, joint, or muscle pain. Bisphosphonates can also cause rare but serious side effects that include permanent bone deterioration of the jaw (osteonecrosis) and, when taken for more than five years, a possible increased risk of thigh fracture. So talk with your doctor about how to reduce your risk of side effects.

Most studies of alendronate and the other osteoporosis medications have involved postmenopausal women with osteoporosis, so it’s not clear how well they work for men or younger women.

This report was published in September 2013.

Cost Comparison

Cost Comparison of Drugs to Prevent Fractures

Note: If the price box contains a

, that indicates the dose of that drug may be available for a low monthly cost through programs offered by large chain stores. For example, Kroger, Sam’s Club, Target, and Walmart offer a month’s supply of selected generic drugs for $4 or a three-month supply for $10. Other chain stores, such as Costco, CVS, Kmart, and Walgreens, offer similar programs. Some programs have restrictions or membership fees, so check the details carefully for restrictions and to make sure your drug is covered.

Best Buy?

Generic Name

Brand Name(s)A

Generic?

Formulation and Frequency of DoseB

Average Cost for a Month’s SupplyC

Bisphosphonates

Alendronate 5 mg tablet

Generic

Yes

One pill daily

$63

Alendronate 10 mg tablet

Generic

Yes

One pill daily

$61

Alendronate 35 mg tablet

Generic

Yes

One pill weekly

$39

Alendronate 70 mg tablet

Generic

Yes

One pill weekly

$41

Alendronate 70 mg tablet

Fosamax

No

One pill weekly

$132

Ibandronate 150 mg tablet

Generic

Yes

One pill monthly

$130

Ibandronate 150 mg tablet

Boniva

No

One pill monthly

$183

Ibandronate 3 mg/3 mL injectable

Boniva

No

3 mg IV every three months

$200

Risedronate 5 mg tablet

Actonel

No

One pill daily

$163

Risedronate 35 mg tablet

Actonel

No

One pill weekly

$181

Risedronate 150 mg tablet

Actonel

No

One pill monthly

$189

Risedronate 35 mg delayed-release tablet

Atelvia

No

One pill weekly

$174

Zoledronic acid 5 mg/100 mL injectable

Reclast

No

5 mg infusion once a year

$107

Zoledronic acid 5 mg/100 mL injectable

Generic

Yes

5 mg infusion once a year

$47

Selective estrogen receptor modulator

Raloxifene 60 mg tablet

Evista

No

One pill daily

$213

Parathyroid hormone

Teriparatide 600 mcg/2.4 mL unit

Forteo

No

20 mcg injection once daily

$1,573

Biologicals

Denosumab 60 mg/mL injection

Prolia

No

60 mg/mL injection every six months

$220

A. “Generic” means this is a generic drug, as noted in column three as well.

B. As commonly recommended or prescribed.

C. Prices reflect nationwide retail average in May 2013, rounded to the nearest dollar. Information derived by Consumer Reports Best Buy Drugs from data provided by Symphony Health Solutions, which is not involved in our analysis or recommendations.

NOTE: The information contained in the Consumer Reports Best Buy Drugs™ reports is for general informational purposes and is not intended to replace consultation with a physician or other health care professional. Consumers Union is not liable for any loss or injury related to your use of the reports. The reports are intended solely for individual, non-commercial use and may not be used in advertising, promotion, or for any other commercial purpose.


Copyright 2010, Consumers Union of United States, Inc

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