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Boniva: 7 things you should know

Medically reviewed by Carmen Fookes, BPharm. Last updated on Jan 3, 2023.

1. How it works

  • Boniva is a brand (trade) name for ibandronate. Ibandronate strengthens bones and may be used for the treatment or prevention of osteoporosis. Ibandronate has a high affinity for hydroxyapatite, which is part of the mineral matrix of bone. It works by inhibiting osteoclasts which are responsible for breaking down and reabsorbing bone (by a process known as bone resorption). In postmenopausal women, ibandronate reduces high rates of bone turnover, increasing on average, bone mass.
  • Boniva belongs to a group of medicines known as bisphosphonates.

2. Upsides

  • Boniva is used in the treatment of osteoporosis in postmenopausal women.
  • Boniva injection only requires administration by a healthcare provider every three months.
  • Boniva tablets are taken once a month and can be taken at home.
  • Boniva is available as a generic under the name ibandronate.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Heartburn, stomach pain, or diarrhea; back, muscle, or joint pain; a headache, and flu-like symptoms are the most common side effects. Injection-site reactions (such as redness or swelling around the injection site) are common with Boniva injections.
  • The optimal duration of use of Boniva has not been determined. Clinical studies of Boniva have only been of one year duration. Discontinuation of therapy should be considered by doctors after 3 to 5 years in patients at low risk of fracture. Patients who discontinue therapy should have their risk for fracture re-evaluated periodically.
  • Boniva injection must be administered by a healthcare provider. Before administration, a blood test to check serum creatinine levels needs to be done as well as a routine oral examination to rule out osteonecrosis of the jaw (ONJ).
  • Oral Boniva, like other bisphosphonates, may irritate the esophagus and stomach. Some cases have been severe enough to warrant hospitalization. The risk is greater in people who lie down soon after taking oral Boniva or who don't take it with a full glass of water. Take exactly as directed. Oral Boniva should be taken on the same day each month, with a full glass of water, and the person taking oral Boniva should not eat or drink anything else and remain upright for 60 minutes after taking it.
  • May not be suitable for some people including those with kidney disease, pre-existing esophageal or gastrointestinal conditions, low blood calcium levels (hypocalcemia), a dental problem, who have difficulty swallowing (applies to oral Boniva), or who are unable to stand or sit upright for at least 60 minutes after taking oral Boniva.
  • There are concerns about the long-term safety of bisphosphonates (such as Boniva) as long-term use has been associated with atypical femur fractures, osteonecrosis of the jaw, and esophageal cancer. The risk of osteonecrosis of the jaw is greater in those who have received chemotherapy, radiation, or steroids.
  • Rarely may cause other side effects including uveitis (eye inflammation) and other adverse effects.
  • Boniva may interact with aspirin; NSAIDs such as ibuprofen, naproxen, or diclofenac; or supplements containing calcium or magnesium.
  • Avoid during pregnancy. Bisphosphonates, such as Boniva, can cause fetal harm in animals, such as renal pelvis ureter syndrome and interference with natural delivery. Animal data suggest that the uptake of bisphosphonates into fetal bone is greater than into maternal bone. There are no data on fetal risk and pregnancy in humans. It is unknown if Boniva is excreted into human milk and use should be avoided.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Boniva helps to increase bone mineral density and is given as a tablet once every month or by injection once every three months. Common side effects include gastrointestinal disturbances and back, muscle, or joint pain.

5. Tips

  • Take oral Boniva first thing in the morning, on the same day each month. Take at least 60 minutes before eating or drinking any food or beverages (other than water), or taking any other medication, including calcium, antacids, or vitamins.
  • Take oral Boniva with a full glass of water and remain upright for at least 60 minutes. Do not lie down. Do not substitute water with mineral water, coffee, soda, juice, or tea. Never take Boniva at bedtime. Take exactly as directed by your doctor. Do not increase or decrease the dosage without your doctor's advice.
  • Avoid eating, drinking (other than water), or taking other medications for 60 minutes after taking oral Boniva.
  • You may need to take supplementary calcium or vitamin D if your dietary intake is inadequate. Your doctor will advise you about this. If you are taking supplemental calcium, iron, magnesium, or antacids, take them at a different time of day to oral Boniva (for example at lunchtime), as they may interfere with its absorption of oral. Note that mineral water may contain a higher concentration of calcium than tap or bottled water, and you should only drink it if your doctor has confirmed it is compatible with oral Boniva.
  • Talk to both your dentist and doctor if you require dental surgery or tooth extraction and you have been on Boniva long-term. They may advise discontinuation of Boniva.
  • Tell your doctor if you experience any thigh or groin pain, muscle cramps or twitches, severe or debilitating muscle pain, eye inflammation, or any other adverse effects of concern while you are taking Boniva (oral or IV).
  • Boniva is only FDA-approved for use in postmenopausal women. But if you inadvertently find yourself pregnant, tell your doctor immediately.

6. Response and effectiveness

  • Boniva rapidly binds to bone or is excreted unchanged in the urine following administration.
  • Administration of Boniva injection for a year increased lumbar spine bone mineral density (BMD) by 1.1% and hip density by 2.1% after one year.
  • Administration of Boniva tablets for one year increased hip BMD by 1.5% after one year.
  • Boniva injection appears to be more effective at increasing BMD than Boniva oral tablets.

7. Interactions

Medicines that interact with Boniva may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with Boniva. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Boniva include:

  • aluminum salts
  • amikacin
  • angiogenesis inhibitors, such as bevacizumab or everolimus
  • aspirin
  • chemotherapy agents for cancer
  • diuretics, such as bumetanide and furosemide
  • iron salts
  • lithium
  • magnesium salts
  • NSAIDs, such as ibuprofen, diclofenac, and naproxen
  • olsalazine
  • oral steroids, such as dexamethasone, prednisone, and methylprednisone
  • sirolimus and tacrolimus
  • zinc salts.

Note that this list is not all-inclusive and includes only common medications that may interact with Boniva. You should refer to the prescribing information for Boniva for a complete list of interactions.


Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Boniva only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2023 Revision date: January 3, 2023.