Both Actonel and Fosamax prevent bone loss after menopause. However, a study by leading osteoporosis experts say Actonel works faster than Fosamax.
Actonel (made by Procter & Gamble) and Fosamax (made by Merck) are both effective treatments for age-related osteoporosis. Age-related osteoporosis is a type of bone loss that is a particular problem for postmenopausal women.
Actonel and Fosamax are members of a class of drugs known as bisphosphonates, as is a newer drug, Boniva made by Roche.
Evidence has indicated that Actonel may work more quickly to prevent fractures, especially the more common hip and non-spine fractures that can greatly reduce a person’s quality of life.
However, how accurrate are these findings?
Nelson B. Watts, M.D., Director of the University of Cincinnati Bone Health and Osteoporosis Center, joined a team of internationally renowned experts in an effort to find out.
In the study, insurance records for 12,215 postmenopausal women who took Actonel and 21,615 women who took Fosamax for the first time were analyzed. All of the women in the study were 65 and older.
The findings suggested that after a year of treatment, the women taking Actonel had 43% fewer hip fractures and 18% fewer non-spine fractures than the women taking Fosamax.
“This adds to the suggestion from clinical trials that Actonel works faster than Fosamax,” Watts tells WebMD. “We found a significantly lower rate of fracture at hip and non-vertebral sites for patients given Actonel vs. Fosamax at both six and 12 months.”
“I am not saying one drug is better than the other — only that Actonel works faster,” Watts says.
The study — sponsored by Procter & Gamble and Sanofi — appears in the November 2006 online issue of the journal Osteoporosis International.
Watts is eager to mention that the study is not a clinical trial and therefore cannot be taken as conclusive proof regarding the two drugs.
On the other hand, the study impresses Holly Thacker, M.D., Director of the Women’s Health Center at The Cleveland Clinic.
Thacker, who was not involved in the study, points out that Watts and colleagues looked at the kind of women doctors see in real life. Moreover, they evaluated the endpoint that really matters to women suffering from osteoporosis — actual bone fractures.
“I tend to prescribe Actonel more often than Fosamax, so this study is reassuring,” Thacker says.
“We now have some excellent drugs for bone loss. In the bisphosphonate family, I rank Actonel No. 1, with Fosamax a close second,” she says. “I rank Boniva a distant third, because it has not yet been shown to reduce hip fracture.”
Describing both drugs as being equal, Watts and Thacker would prescribe Actonel over Fosamax.
But both of these top doctors bring up a valid point - not all women are equal. Some women may have a higher tolerance to one drug over the other. Or their insurance may pay more for one drug than the other.
In either scenario, women will benefit the most from the drug that works best for them.
Watts adds that bone-loss drugs should be taken for several years. But most patients stop taking them after six or seven months — greatly reducing their potential benefit.
“When we start someone on osteoporosisosteoporosis treatment, we hope they will continue taking it for years,” Watts says.
“But bone loss is a silent disease — like high blood pressurehigh blood pressure or high cholesterolhigh cholesterol. Until something happens, the disease doesn’t make them feel bad, and the drug doesn’t make them feel better. That is sometimes hard for people to accept,” he says.
Thacker also stresses the importance of long-term treatment. Unlike Watts, who usually begins drug treatment only when a woman has frank osteoporosis, Thacker begins as soon as she detects the slightest bone loss in the patient.
“Once you’re starting to lose bone mass, you need to be on treatment,” Thacker says.
“First, we make sure a woman is getting enough calcium and vitamin D,” Thacker says. “But if she is, and she’s still losing bone mass, we start treatment. It is a long-term commitment. The chances are, you will be on it for a long time.”