Table 1.

Comparative features of four nitrogen-containing bisphosphonates commonly used for the treatment of osteoporosis.

	Alendronate	Risedronate	Ibandronate	Zoledronate
Brand name	Fosamax	Actonel	Boniva, Bonviva	Reclast, Aclasta
Approval date*	1995	2000	2003	2007
R1 side chain	OH	OH	OH	OH
R2 side chain	(CH2)3NH2	CH2-3-pyridine	CH2CH2N(CH3)(pentyl)	CH2-imidazole
Ranking of affinity for hydroxyapatite [Nancollas et al. 2006]	2	4	3	1
Ranking of antiresorptive potency [Dunford et al. 2001]	4	2	3	1
Administration	Oral	Oral	Oral, IV	IV
Dose	10 mg/day, 70 mg/week	5 mg/day, 35 mg/week, 150 mg/month, 75 mg/day for 2 consecutive days once monthly	Oral 150 mg/month, IV 3 mg every 3 months over 15–30 seconds	5 mg every 12 months over at least 15 minutes
Reduction of vertebral fracture risk	Yes [Cummings et al. 1998; Black et al. 1996]	Yes [Reginster et al. 2000; Harris et al. 1999a]	Yes [Chesnut et al. 2004]	Yes [Black et al. 2007]
Reduction of non-vertebral fracture risk	Yes [Black et al. 2000; Pols et al. 1999]	Yes [Harris et al. 1999b]	Not demonstrated except in post hoc subgroup analysis of high risk patients [Chesnut et al. 2004]	Yes [Black et al. 2007]
Reduction of hip fracture risk	Yes [Black et al. 1996]	Yes [McClung et al. 2001]	Not demonstrated	Yes [Black et al. 2007]
Comments	Available in inexpensive generic formulations	Added convenience of monthly oral dosing	Two dosing forms with long dosing intervals, IV dosing benefits patients unable to use oral bisphosphonates	IV dosing with longest dosing interval

Demonstration of fracture risk reduction considers only prospective randomized placebo-controlled clinical trials. IV, intravenous.

^*Year of first approval by the United States Food and Drug Administration for the treatment of postmenopausal osteoporosis.