From the Guidelines

Ibandronate and alendronate are both bisphosphonates used to treat osteoporosis, but the choice between them depends on individual patient factors.

Alendronate has a more established efficacy and safety profile, with high-quality evidence showing its effectiveness in reducing vertebral, nonvertebral, and hip fractures in postmenopausal osteoporotic women 1.
Ibandronate, on the other hand, has been shown to reduce the risk of radiographic vertebral fractures, although evidence is insufficient to determine its effect on hip fractures 1.

As a general recommendation, alendronate 70mg weekly or 35mg daily is often preferred due to its more established efficacy and safety profile.
Ibandronate 150mg monthly or 3mg intravenously every 3 months may be considered for patients who cannot tolerate alendronate or have difficulty with daily or weekly oral medication.

It's essential to assess patient-specific factors, such as renal function, esophageal disorders, and medication adherence, before selecting between these two medications 1.
Patients with esophageal emptying disorders or those who cannot sit upright should avoid oral bisphosphonates, including alendronate and ibandronate, due to the risk of pill esophagitis 1.

Duration of treatment should be individualized, but generally, treatment is continued for 5-10 years, with regular monitoring of bone density and fracture risk.
The American College of Physicians recommends treating osteoporotic women with pharmacologic therapy for 5 years, although this is based on low-quality evidence 1.

From the Research

Ibandronate and alendronate are both bisphosphonates used in the treatment of postmenopausal osteoporosis 2, 3, 4.
Ibandronate has been shown to have a higher affinity for hydroxyapatite compared to risedronate, but less than other bisphosphonates, which could affect its skeletal distribution and rate of action offset 2.
Alendronate is one of the most widely used bisphosphonates for the treatment of postmenopausal osteoporosis, administered orally either daily or once weekly 4.
Ibandronate is administered once monthly and has been shown to have similar efficacy to alendronate in terms of bone mineral density and fracture risk 4, 5, 6.

Studies have shown that ibandronate and alendronate have similar efficacy in increasing bone mineral density at the lumbar spine and total hip 5, 6.
Ibandronate has been shown to have a higher adherence rate compared to alendronate, which could be an important factor in the treatment of osteoporosis 3, 5.
Both ibandronate and alendronate have been shown to be well tolerated, with similar adverse event profiles 5, 6.

A study comparing once-monthly ibandronate with once-weekly alendronate found that persistence on treatment was significantly higher in the ibandronate group 3.
The study found that the estimated proportion of patients persisting with treatment at 6 months was 56.6% in the ibandronate group and 38.6% in the alendronate group, resulting in a 47% relative improvement in persistence with ibandronate 3.

The MOTION study, a 12-month randomized trial, found that once-monthly ibandronate was non-inferior to weekly alendronate in increasing bone mineral density at the lumbar spine and total hip 6.
The PERSIST study, a 6-month randomized trial, found that persistence on treatment was significantly higher in patients receiving once-monthly ibandronate plus a patient support program compared to once-weekly alendronate 3.
A randomized trial comparing monthly ibandronate and weekly alendronate in patients with primary biliary cirrhosis found that both treatments resulted in significant increases in bone mineral density, with higher adherence rates in the ibandronate group 5.