Can't Take a Bisphosphonate? Prolia May Be Right For You

Patient Expert

We're all familiar with bisphosphonates - "the drugs we love to hate." Prolia (denosumab), which earned FDA approval in June, 2010, is not a bisphosphonate; it's a new type of "biologic" drug: a monoclonal antibody.

Like bisphosphonates, Prolia focuses on osteoclasts, cells that break down your bones, causing them to "shed" and lose density. But it does it in a different way: by targeting a protein called RANK ligand, which controls the activity of osteoclasts. Prolia effectively causes RANK ligand to tell osteoclasts to stop working; thus your bones stop shedding. Researchers feel it's a more targeted, less "invasive" way to slow bone loss than that offered by bisphosophonates.

Happily, and most important to the end user, Prolia doesn't come with the array of potential gastrointestinal side effects that bisphosphonates carry - nor their inconvenient dosing schedule.

Is it recommended for me?

"¨Prolia is recommended for you if you meet at least one of these criteria:
-You're a postmenopausal woman at increased risk for bone fracture;
-You're unable to take another osteoporosis medication due to gastric issues;
-Other osteoporosis medications haven't worked well for you.

So, how do you know if you're at increased risk for bone fracture? The following factors, which closely follow the general risk factors for osteoporosis, increase fracture risk. If you can claim more than one of these, Prolia may be a good choice for you.
-Family history of osteoporosis;
-Small/thin frame;
-Lifestyle: smoking, excessive drinking (more than 2 drinks per day); lack of exercise;
-Diet: low levels of calcium and/or vitamin D;
-History of falls/previous broken bones as an adult;
-Medications that can increase bone loss (e.g., steroids, certain breast cancer drugs);
-T-score below -2.5.

You shouldn't take Prolia if your blood calcium level is too low; your doctor will ascertain this. Also, you should let your doctor know if you've had parathyroid or thyroid surgery; have kidney problems; have trouble absorbing minerals (malabsorption syndrome); or are planning dental surgery.

How will it help me?
Prolia has been shown to reduce the incidence of vertebral, hip, and non-vertebral fractures: in other words, all fractures.

When and how would I take it?"¨

Prolia is injected subcutaneously (under the skin) twice a year. You'll need to go to your doctor's office for the injection."¨

And what are the common side effects?"¨

The most common side effects include pain in the back, arms, legs, and muscles; elevated cholesterol levels, and bladder infections.

Less common side effects are dermatitis and eczema (skin rashes); skin, abdominal, and ear infections; and a weakened immune system, which can lead to any type of infection.

Osteonecrosis of the jaw, a potentially serious breakdown of the jaw bone, is a rare side effect; when you start taking Prolia, you should tell your dentist.

Is there anything I can do to avoid side effects?
Aside from practicing good mouth care to avoid dental and jaw issues, no. Just be aware of side effect symptoms, and report any health changes to your doctor.

Bottom line
Pros: Prolia works equally well for all types of fractures, not just hip or vertebral. You'll avoid the gastrointestinal issues common with bisphosphonates; and it's taken just twice a year.

"¨Cons: It's only advised for postmenopausal women with an increased risk of bone fracture. And, due to lack of long-term data, it's not known whether Prolia may actually cause fractures, or slow bone healing, over time.

Read about other osteoporosis drugs:

Bisphosphonates: Boniva, Fosamax, and Actonel

Intravenous bisphosphonates: Boniva IV and Reclast  

Calcitonin and Forteo

SERMS and estrogen: Evista, Premarin, and Prempro