Prolia (Denosumab): 9 Things to Know About This Osteoporosis Injection

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Osteoporosis is a health condition characterized by weakened bones. It's the most common bone disease in the U.S.

If you have osteoporosis, you're at higher risk of breaking a bone. Luckily, there are many ways to keep your bones strong. Medications are one way to prevent or treat osteoporosis. There are several options, including bisphosphonates, parathyroid hormone-related medications, and monoclonal antibodies.

Prolia (denosumab) is one example of an injectable osteoporosis medication. It's a first-choice osteoporosis medication in postmenopausal women who are considered "very high risk" for fractures. This includes postmenopausal women who've had multiple fractures in the past or who have severe bone loss. If you're prescribed this osteoporosis injection, there's plenty to learn, as we'll cover below.

1. What is Prolia used for?

Prolia is used to treat osteoporosis in men and postmenopausal women who are at high risk of fracture. It can also treat osteoporosis caused by steroid medications in both men and women.

Additionally, Prolia can be used to strengthen bones for women who take certain breast cancer medications (aromatase inhibitors) and men who take certain prostate cancer medications (antiandrogen therapy).

2. Is Prolia a bisphosphonate?

No, Prolia isn't a bisphosphonate. Prolia is a monoclonal antibody. Bisphosphonates are a different class of medications for treating osteoporosis.

Prolia is only available as a brand-name medication. But most bisphosphonates are available as generics. One example of a bisphosphonate is Fosamax (alendronate), which can be taken once daily or once a week. Ibandronate (formerly known as Boniva) is another option. Ibandronate tablets are taken once a month, and the injectable version is used once every 3 months. Prolia is administered less frequently - every 6 months.

Bisphosphonates work well and are often first-choice medications for osteoporosis. But they do have side effects, especially gastrointestinal (GI) ones. These include nausea, vomiting, and constipation. They can also cause diarrhea and heartburn. Less commonly, they can cause more serious risks, such as ulcers in your esophagus and osteonecrosis of the jaw (breakdown of the jaw).

Prolia can also cause osteonecrosis of the jaw, but it isn't as likely to cause GI problems. However, it can cause pain throughout the body and increase your risk of infection. Both bisphosphonates and Prolia can cause low calcium levels.

Bisphosphonates also need to be taken in a specific way: on an empty stomach with a full glass of water. And you should wait at least 30 minutes after taking Fosamax and 60 minutes after taking ibandronate before you eat or lie down. This reduces the likelihood of GI side effects.

3. How does Prolia work?

As mentioned above, Prolia is an osteoporosis injection that's a type of monoclonal antibody. It's also classified as a RANK ligand (RANKL) inhibitor. RANKL is a protein in your body whose usual purpose is to help a certain type of cell called osteoclasts function.

Osteoporosis occurs when osteoclasts are too active. These are bone cells that are responsible for breaking down old bone. Usually, new bone develops in its place. But if you have osteoporosis, your osteoclasts are overly active. So bone is broken down before new bone is formed to replace it.

Prolia works by blocking RANKL from attaching to its receptors (binding sites). This decreases the amount of osteoclasts in your body and makes the existing ones less active. This helps prevent bone loss and strengthens your bones.

4. How is Prolia administered?

Prolia is a subcutaneous (SQ) 60 mg injection. SQ injections are given under the skin.

Prolia is typically given every 6 months in the upper thigh, upper arm, or abdomen. Prolia should only be administered by a healthcare professional.

Prolia can cause low calcium levels. So your prescriber may check the level of calcium in your blood before starting Prolia. It's recommended that anyone receiving Prolia also takes at least 400 international units (IU) of vitamin D and 1,000 mg of calcium daily.

Keep in mind that the recommended amount of vitamin D and calcium may be different for you. For example, if you're deficient in vitamin D, you may need more than 400 IU per day. Talk to your prescriber about whether you need to have your vitamin D levels checked before starting Prolia.

5. Does Prolia cause side effects?

Prolia is generally considered safe. But like all medications, it has side effects, including some rare but more serious risks.

Side effects of this osteoporosis injection include back and muscle pain, runny nose, and high cholesterol levels. It may also cause bladder infections and skin reactions, such as rash and itching.

Although it's rare, Prolia can also cause more serious side effects. These include serious infections and low calcium levels (hypocalcemia). It can also cause thigh bone or femur fractures and osteonecrosis of the jaw.

If you're pregnant, you shouldn't take Prolia. If you're taking Prolia and you're able to become pregnant, you should use contraception during treatment and for 5 months after your last dose.

6. Does Prolia have drug interactions?

Prolia isn't known to have any direct drug interactions. This means Prolia doesn't increase or decrease levels of other medications. And other medications aren't known to affect Prolia levels either. But there's another medication that contains the same active ingredient (denosumab) as Prolia. It's called Xgeva. These medications shouldn't be used together.

Additionally, taking Prolia with certain medications can make certain side effects more likely. For example, Prolia can increase your risk of infection. If you take medications that lower your immune system activity, you may be more likely to experience infections. This includes medications like steroids or immunosuppressants.

Another drug interaction can occur between Prolia and medications that decrease calcium levels. This includes bisphosphonates like alendronate and diuretics such as furosemide (Lasix).

Additionally, some experts recommend waiting 4 to 7 days in between receiving a Prolia injection and a COVID-19 vaccine. This is to lower the chance of severe injection site reactions. Talk to your prescriber about whether you should wait between Prolia injections and other vaccines.

Your healthcare team can help you prevent interactions between Prolia and other medications. Proving them with an updated list of your medications can help them screen for interactions.

7. Are there other injections that treat osteoporosis?

Prolia isn't the only injectable medication for osteoporosis. Other shots for osteoporosis also exist. Some are given SQ, like Prolia, while others are intravenous (IV), such as Reclast (zoledronic acid) and ibandronate injection. Other SQ medications for osteoporosis include Forteo (teriparatide), Tymlos (abaloparatide), and Evenity (romosozumab-aqqg).

Usually, these injectable medications are only prescribed when oral osteoporosis medications don't work or can't be used. But they may be considered first-choice options for certain people with osteoporosis who are at very high risk for fractures. Talk to your prescriber about which osteoporosis injection or pill is right for you.

How to save on Prolia

Prolia is only available as a brand-name medication. But there are ways to save:

• Save with a patient assistance program. If you're uninsured or underinsured, you may be eligible for Prolia's patient assistance program. This program offers Prolia free of cost if you meet certain income requirements.

• Save with a copay savings card. If you have commercial insurance and meet eligibility requirements, Prolia may be as little as $25 per dose with a savings card from the manufacturer.

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