Harvard Women's Health Watch

Ask the doctor: What do you know about Prolia and Reclast for osteoporosis?

Q. I'm looking for information on Prolia and Reclast as alternatives to Boniva.

A. All of the drugs you mention are used to treat postmenopausal women with osteoporosis, although they're in different drug classes. Ibandronate (Boniva) and zoledronic acid (Reclast, Zometa) are bisphosphonates; denosumab (Prolia) is a monoclonal antibody. Bisphosphonates interfere with the activity of osteoclasts, bone cells that are involved in normal remodeling. Osteoclasts break down (resorb) old bone. Bisphosphonates work by reducing the rate of resorption. Denosumab also reduces bone resorption but does so by inhibiting the formation of osteoclasts rather than their activity.

All three drugs suppress bone remodeling, increase bone density, and reduce the risk of fractures. Denosumab and zoledronic acid reduce fractures at both the spine and hip, but ibandronate reduces only spine fractures. Consequently, clinicians recommend ibandronate less often than two other bisphosphonates — alendronate (Fosamax) and risedronate (Actonel).

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