It's the side-effects issue that terrifies everyone. What is so interesting/troubling, though, is that a drug and dosage that sends one person to the ER is perfectly tolerated by another who reports they didn't feel a thing. You just have to find the one with the cost-benefit analysis that works for you. If you hate the Actonel pill, you can just stop. That's the nice part about pills. It's the infusions that still scare me-- and that's what comes at the end of Tymlos. So, even though I've done my time with Actonel, I'm still right there with you regarding fear of the unknown.