Key takeaways

  • Boniva is a prescription medication for osteoporosis after menopause. You may experience side effects ranging from mild issues like indigestion and headaches to more serious concerns such as low calcium, esophageal irritation, and rare teeth and jaw problems.
  • To reduce the risk of esophageal irritation, take Boniva exactly as directed: with a full glass of water while sitting or standing upright, and remain upright for at least 1 hour afterward.
  • If you experience severe pain in your muscles, bones, or joints while taking Boniva, contact your doctor. This may be a symptom of a bone fracture or other serious issues requiring medication adjustment.
Boniva has been discontinued

Boniva was removed from the market in 2023 and is no longer available.

While Boniva is no longer prescribed by healthcare professionals, a generic version called ibandronate oral tablet is available. The information about Boniva in this article also applies to ibandronate unless otherwise noted.

For more information about ibandronate, see the drug’s prescribing information.

Boniva is a prescription medication used to treat and prevent osteoporosis after menopause.

Boniva comes as a tablet that you swallow. You take it once per month. The active ingredient in Boniva is ibandronate. (An active ingredient is what makes a medication work.)

You’ll likely take Boniva long term. But it’s important to note that the safety and effectiveness of Boniva when taken for longer than 3 years isn’t known. The length of time you take the drug may depend on your personal risk of bone fractures.

This article discusses possible side effects of Boniva and how to manage them. For more information about Boniva, including details about its uses, see this Boniva overview article.

Boniva can cause side effects, some more common than others. These side effects may be temporary, lasting a few days to weeks. Talk with your doctor if side effects do not go away, get worse, or become too difficult to tolerate.

Boniva’s commonly reported side effects include:

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Examples of mild side effects that have been reported with Boniva include:

For more information about some of these side effects, see the “Tips for managing side effects” section.

In most cases, these side effects should be temporary. And some may be easily managed, too. But if you have any symptoms that are ongoing or bother you, talk with your doctor or pharmacist. And do not stop taking Boniva unless your doctor recommends it.

Boniva may cause mild side effects other than the ones listed. See Boniva’s prescribing information for details.

Serious side effects that have been reported with Boniva include:

For more information about some of these side effects, see the “Tips for managing side effects” section.

If you develop serious side effects while taking Boniva, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. Sharing your experience helps make medication safer for everyone by giving doctors and researchers more information about how the drug works in real life. If you develop a side effect while taking Boniva and want to tell the FDA about it, visit MedWatch or call 800-FDA-1088.

Allergic reaction

For some people, Boniva can cause an allergic reaction. In general, symptoms of an allergic reaction can be mild or serious.

What might help

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest a treatment to manage your symptoms and can determine whether you should keep taking Boniva.

If you have symptoms of a severe allergic reaction, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

If your doctor confirms you’ve had a serious allergic reaction to Boniva, they may have you switch to a different treatment.

Learn more about some of the side effects Boniva may cause.

Problems with your teeth and jaws

Some people may experience teeth and jaw problems during their Boniva treatment. Specifically, Boniva may cause a rare but serious side effect called osteonecrosis of the jaw. With this condition, reduced blood flow to your jaw causes damage to your jawbone. It can lead to dental side effects, including loose teeth or slow healing after dental work (such as having a tooth pulled).

It’s important to note that osteonecrosis of the jaw was not reported during studies of Boniva. There have been reports of this side effect in people taking Boniva after the drug became available for use. But it’s unclear how often this has happened or whether Boniva was the cause.

Symptoms of osteonecrosis of the jaw may include:

  • jaw pain or discomfort
  • mouth sores
  • loose teeth

Problems with your teeth and jaws may occur at any time while you’re taking Boniva. But these problems are more likely to develop after you’ve been taking the medication for a long time.

What might help

Before starting Boniva treatment, your doctor will likely examine the inside of your mouth. They may recommend visiting a dentist so they can resolve any dental issues before you start taking Boniva.

To lower your risk of teeth and jaw problems while taking Boniva, it’s important to take good care of your mouth and teeth. For example, you should brush and floss your teeth daily. Your doctor or dentist may also recommend using a mouthwash.

If you need any dental work done while taking Boniva, be sure to talk with your doctor or dentist beforehand. They may recommend that you stop taking Boniva temporarily to lower your risk of teeth and jaw problems.

If you have any symptoms of jaw osteonecrosis while taking Boniva, contact your doctor or dentist right away. They may recommend that you stop taking Boniva.

Irritation of your esophagus

Boniva can irritate your esophagus. In rare cases, this could lead to serious problems, such as inflammation (swelling), ulcers (sores), bleeding, or holes in the lining of your esophagus. These problems may need treatment in the hospital.

Symptoms of irritation of the esophagus may include:

  • new or worsening heartburn
  • chest pain
  • difficulty swallowing or pain when swallowing
  • getting food stuck in your throat

What might help

Irritation of your esophagus usually only happens if Boniva stays in your esophagus too long.

To help avoid this, it’s important to take the tablet exactly as instructed by your doctor. Be sure to:

  • always take Boniva right after you get up in the morning, while sitting or standing upright
  • swallow the tablet whole with a full glass (6 to 8 ounces) of plain water
  • avoid sucking or chewing the tablet
  • stay sitting or standing upright for at least 1 hour after taking the tablet

If you have a problem with your esophagus or a condition that causes difficulty swallowing, this can also raise your risk of irritation to your esophagus. In this case, your doctor will likely not prescribe Boniva.

If you have any symptoms of irritation to your esophagus while taking Boniva, contact your doctor right away. You should not take any further doses of Boniva until your doctor confirms it’s safe to do so.

Pain in your muscles, bones, or joints

Boniva can sometimes cause pain in your muscles, bones, or joints. But in studies, severe pain in these areas wasn’t a common side effect.

If you do have pain in your muscles, bones, or joints, it’s likely to be mild. But some people may experience severe pain.

Pain may develop as early as 1 day after starting Boniva. Or it may develop after a few months of treatment. But any pain you have during treatment usually eases after you stop taking Boniva.

What might help

It may be possible to relieve mild pain in your muscles, bones, or joints through massage, stretching, or relaxation techniques. You can also ease mild pain with over-the-counter pain relievers. You can ask your doctor or pharmacist to recommend one that’s safe for you to take.

If you have severe or bothersome pain in your muscles, bones, or joints, talk with your doctor. They may recommend that you stop taking Boniva and switch to a different treatment.

It’s important to note that pain in your thigh, hip, or groin could be a symptom of a thigh fracture. (See the section directly following to learn more.) And if you have pain in your jawbone, this could be a symptom of problems with your teeth and jaw. (See the section directly preceding this one to read more about this.)

If you have questions or concerns about pain you’re experiencing while taking Boniva, talk with your doctor.

Thigh bone fractures

Boniva may raise the risk of fractures (breaks) of the thigh bone. These fractures may happen with light force to the thigh bone, such as a bump, or with no contact at all.

Thigh bone fractures weren’t reported in studies of Boniva. There have been reports of this side effect in people taking Boniva after the drug became available for use. But it’s unclear how often this has happened or whether Boniva was the cause.

Symptoms of a thigh bone fracture may include:

  • new or unusual pain in your thigh, hip, or groin
  • dull ache in your thigh (this may go on for a few weeks or months before a fracture occurs)

You may have a higher risk of thigh bone fractures if you take corticosteroid medications with Boniva. Corticosteroids are drugs that reduce inflammation. Examples include prednisone (Rayos) and dexamethasone.

What might help

If you have symptoms of a thigh bone fracture while taking Boniva, contact your doctor right away. They may order X-rays to check for fractures in both legs.

If you have a fracture, your doctor will likely recommend that you stop taking Boniva while the fracture heals. They may also recommend switching to a medication other than Boniva.

Here are answers to some commonly asked questions about Boniva’s side effects.

Does Boniva cause weight gain?

No, Boniva isn’t known to cause weight gain. This wasn’t a side effect reported in studies of the drug.

Boniva is used for osteoporosis after you’ve gone through menopause. It’s common to gain some weight after menopause. This could be due to changes in your hormone levels, metabolism, or lifestyle. So weight gain during Boniva treatment may be due to menopause rather than the drug.

If you’re concerned about weight gain while taking Boniva, talk with your doctor.

Are there side effects of stopping Boniva treatment?

No, there aren’t any side effects associated with stopping Boniva treatment. The medication doesn’t cause withdrawal symptoms (side effects that can happen when you stop taking a drug that your body has become dependent on.) Because of this, there’s no need to taper off treatment slowly.

If you have questions about ending Boniva treatment, talk with your doctor.

Is Boniva given as an injection or infusion? If so, what are the side effects?

No, Boniva is not given as an injection or intravenous (IV) infusion (an injection into a vein that’s given over a period of time). Boniva is only available as a tablet. The injection form of Boniva is no longer available in the United States.

A generic version of the Boniva injection called ibandronate injection is available. To find out more about this generic option, talk with your doctor.

Are the side effects of Boniva and Fosamax the same?

Boniva and Fosamax (alendronate) are drugs used to prevent and treat osteoporosis after menopause. They belong to the same group of drugs, meaning they have many similar side effects.

Both drugs can cause the same serious side effects, including irritation of the esophagus, teeth and jaw problems, and thigh fractures. The mild side effects of these drugs are also similar.

To learn more about how Boniva and Fosamax compare, see this article.

Is hair loss a side effect of Boniva?

No, Boniva isn’t known to cause hair loss. Hair loss can occur with other medications used for osteoporosis, such as Fosamax. But this side effect wasn’t reported in studies of Boniva.

It’s common to have some hair loss after menopause. So hair loss while taking Boniva may be due to menopause rather than the drug.

If you’re concerned about hair loss while taking Boniva, talk with your doctor.

Boniva may not be right for you if you have certain medical conditions. These are known as drug-condition interactions. Other factors may also affect whether Boniva is a good treatment option for you.

Talk with your doctor about your health history before starting Boniva. The following list includes factors to consider.

Esophagus problems: Boniva can irritate your esophagus. Due to this risk, your doctor will likely not prescribe Boniva if you have certain problems with your esophagus or have difficulty swallowing. They can suggest another medication that may be safer for you.

Difficulty sitting or standing up for an extended time: You’ll need to sit or stand upright for at least 1 hour after taking Boniva. This helps the tablet pass into your stomach and lowers the risk of it irritating your esophagus. If you have difficulty sitting or standing for at least 1 hour, your doctor will likely not prescribe Boniva. They can talk with you about other treatment options that may be safer for you.

Low calcium level: Boniva can lower the calcium level in your blood. If you already have a low calcium level or have problems absorbing calcium, your doctor will likely want to address this before you take Boniva. They may prescribe a calcium and vitamin D supplement for this purpose. They might also have you take this supplement during your Boniva treatment.* If you have low calcium, talk with your doctor before taking Boniva.

Risk of teeth and jaw problems: Boniva can cause teeth and jaw problems. If you have cancer or anemia, you may have a higher risk of these problems. Talk with your doctor about whether Boniva is right for you. You may also have a higher risk of these problems if you have dental health issues or wear dentures that don’t fit well. Having certain dental work done while taking Boniva can also raise your risk.

Your doctor may recommend visiting a dentist before you start Boniva treatment. And it’s important to talk with your doctor or dentist before having any dental work done while taking Boniva.

Severe kidney problems: Your kidneys help clear Boniva from your body. If you have a severe kidney problem, your doctor will likely not prescribe Boniva. Ask them about other medications that may be safer for you.

Allergic reaction: If you’ve had an allergic reaction to Boniva or any of its ingredients, your doctor will likely not prescribe Boniva. Ask them what other medications are better options for you.

* After taking a dose of Boniva, you should not take a calcium and vitamin D supplement for at least 1 hour. Taking calcium at the same time as Boniva can make the drug less effective.

Alcohol and Boniva

Drinking alcohol with Boniva does not affect the way Boniva works. But it may raise your risk of certain side effects, such as indigestion, nausea, headache, or dizziness.

It’s important to note that drinking large amounts of alcohol can raise your risk of developing osteoporosis (the condition Boniva is prescribed to help treat and prevent).

If you drink alcohol, talk with your doctor about how much may be safe to drink with your condition and treatment plan.

Pregnancy and breastfeeding while taking Boniva

It’s not known whether Boniva is safe to take during pregnancy or while breastfeeding. If you have questions about taking Boniva while pregnant or breastfeeding, talk with your doctor.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.