The bisphosphonates are a popular family of medications used to treat osteoporosis. The following drugs are all in the bisphosphonate family: Fosamax, Actonel, Boniva, and Reclast.  See detailed descriptions of each of these on the following pages.

These medications are all very similar with some differences. While most osteoporosis experts feel that the bisphosponates generally give patients the same amount of bone building, one study did show that Fosamax increased bone density more than Actonel. Also, you may have fewer side effects with one than another which can guide your choice. 

How to take your bisphosphonate:

If you are taking a bisphosphonate in tablet form, then you should take it in a very   specific way to make sure that it is absorbed well and to lower your chances of having stomach upset. Stomach upset is the most common side effect when these drugs are taken by mouth. About 10% of the people who take them have stomach upset.

Bisphosphonates should be taken in the following way to assure absorption and lower the chances of stomach upset:

  • Take your bisphosphonate first thing in the morning when your stomach is empty


  • Swallow the tablet whole with 8 ounces of plain water.


  • Do not eat, drink, or take any other medications or supplements for 30 minutes after you take Fosamax and weekly Actonel and for 60 minutes after you take Boniva or monthly Actonel.


  • Stay upright (do not lie back down) for 30 minutes after you take Fosamax or week Actonel and for 60 minutes after you take Boniva.


  • If you forget to take your Fosamax or weekly Actonel on your usual day, just take it the next morning and then continue on your usual schedule.


  • If you forget to take your Boniva or monthly Actonel and your usual day is 7 or more days away, just take it the next morning and then continue on your usual schedule.

Your doctor may prescribe intravenous (I.V.-meaning it goes directly into the vein) Boniva or Reclast (which is an infusion-also going directly into a vein) if you have side effects, such as stomach upset, with the bisphosphonates that you take by mouth.

Reclast (Zoledronic Acid)