Alternatives to Prolia

Prolia is an FDA-approved brand-name medication manufactured by Amgen Inc. used to treat bone loss and osteoporosis (a weakening of the bones). Prolia is used specifically to treat:

  • Postmenopausal osteoporosis in women who have a high risk of bone fractures
  • Osteoporosis in men who have a high risk of bone fractures
  • Bone loss in women who are receiving adjuvant aromatase inhibitor hormone therapy for breast cancer
  • Bone loss in men who are receiving androgen deprivation therapy (ADT) for prostate cancer

Prolia is not recommended to treat osteopenia. Osteopenia is a condition where your bones are not as strong as normal but also not as weak as they would be if you had osteoporosis.

Here, we will look at what Prolia is, how it works, its side effects, and some of the alternative treatments available.

How does Prolia work?

Bone is a living tissue that needs to be maintained by your body. Certain conditions can interfere with this and can affect the health of your bones. This can lead to bone loss, and a condition called osteoporosis. Osteoporosis is a weakening of your bones that makes them more likely to have hip and vertebral fractures. It’s caused by having low bone density or by losing too much bone mass.

The hormones estrogen and testosterone help keep your bones healthy. Menopause can cause estrogen levels to fall in women, as can certain hormone therapies. This can lead to bone loss and osteoporosis. Likewise, declines in testosterone in men, such as those caused by prostate cancer treatments, can also result in bone loss and osteoporosis.

The active ingredient in Prolia is called denosumab. It helps counter bone loss and osteoporosis by reducing the rate at which your body loses bone tissue. Your body continually replaces old bone tissue with new bone tissue. Part of this process of bone turnover involves a protein called RANKL that helps produce a type of cell that breaks down bone. Denosumab works by blocking RANKL, stopping it from producing the cells that break down bone. This reduces the rate at which your body removes bone tissue, causing the bone mass to increase over time.

What is the most common side effect of Prolia?

The most common possible side effects of Prolia in clinical trials include:

  • Arm and leg pain
  • Bone and joint pain
  • Muscle pain
  • Hair loss
  • Constipation
  • Skin rashes and eczema
  • Frequent and painful urination
  • Blood in the urine

Prolia can cause more serious side effects, including:

  • Allergic reactions
  • Skin infections
  • Other serious infections
  • Jaw bone damage (osteonecrosis of the jaw)
  • Low calcium levels in the blood. Prolia is recommended in combination with calcium and vitamin D supplements.
  • Unusual fractures of the thigh bone

You are encouraged to report the negative side effects of prescription drugs to the FDA. Visit, or call 1-800-FDA-1088.

Prolia warnings & precautions

Don’t take Prolia if you:

  • Are allergic to the active ingredient denosumab
  • Are allergic to any of the other ingredients in Prolia (these are listed in the leaflet which comes with the medication)
  • Have low calcium levels in your blood (hypocalcemia)
  • Are under 18 years of age

Talk to your physician before taking Prolia if you:

  • Have cancer
  • Have ever had severe kidney problems, kidney failure, or have been on dialysis
  • Have poor dental health or any problems with your teeth or mouth, like gum disease
  • Are going to have a tooth extracted
  • Are a smoker (this can increase the risk of dental problems)
  • Have an allergy to latex (the cover of the pre-filled syringe contains a derivative of latex)
  • Are pregnant or trying to become pregnant
  • Are breastfeeding or plan to breastfeed

You should always check with your healthcare provider before taking any medication, including Prolia, to make sure it is safe for you. Be sure to tell your doctor about all other medications you’re taking, including over-the-counter drugs, vitamins, and herbal supplements, as they can interact with Prolia.

Is taking Prolia worth the risk?

The National Women’s Health Network recommends that Prolia only be used as a treatment option in post-menopausal women suffering from severe osteoporosis or when other osteoporosis medications have not worked. Prolia has an extensive list of side effects. However, not all the side effects of Prolia from long-term use are known and it is not clear if the benefits of using Prolia outweigh its risks.

What drug is equal to Prolia?

There are other osteoporosis drugs available for the treatment and/or prevention of osteoporosis, such as Reclast (zoledronic acid), Boniva (ibandronate), Fosamax (alendronate), Evenity (romosozumab), Evista (raloxifene), Miacalcin (calcitonin), and Forteo (teriparatide) or Tymlos (abaloparatide), which are based on parathyroid hormone (PTH) and are often used to treat severe osteoporosis.

What is the safest drug for osteoporosis?

Bisphosphonates such as Reclast, Fosamax, and Actonel (risedronate) are the first choice for osteoporosis treatment. Fosamax is taken as a once-weekly pill. Actonel is taken as a once-weekly or monthly pill. Reclast is given intravenously.

Is Reclast Better than Prolia?

In studies, Prolia was seen to have a greater increase in spine bone mineral density/BMD (a measure of bone health) at 1 year than Reclast, but not significantly. Reclast also had a greater incidence of causing mild flu-like symptoms. Prolia is a relatively new medication, and patient numbers for the study were relatively low. Further studies are needed to investigate the efficacy of Prolia.

What is the difference between Actonel and Prolia?

Prolia and Actonel are both used for the treatment of osteoporosis in women at high risk of bone fracture after menopause. Actonel may also be used for the treatment or prevention of osteoporosis in men and for the treatment of Paget’s disease of bone. Prolia is classed as a monoclonal antibody, and Actonel is classed as a bisphosphonate.

Is Prolia a cancer drug?

Prolia is a targeted drug treatment and is used for the treatment of secondary bone cancer. Prolia also helps to strengthen bones for certain types of cancer. Prolia is also used to increase low bone mass in patients with prostate cancer or breast cancer who are at high risk of fractures.

Prolia Dosage

Prolia is available in solution form in the following doses: prefilled syringes containing 60 mg in 1 mL or single-use vials containing 60 mg in 1 mL.

Prolia is given by a healthcare professional as a subcutaneous injection every 6 months in the upper arm, upper thigh, or abdomen. Patients are advised to take calcium 1000 mg each day and at 400 IU of vitamin D each day.

Medically reviewed

A medical professional has reviewed this article.

Jamie Winn, PharmD
Jamie Winn, PharmD

Jamie Winn, PharmD

Medical Writer & Reviewer

Jamie Winn, PharmD

Medical Writer & Reviewer

Dr. Jamie Winn received his Doctor of Pharmacy in 2002 from the University of South Carolina College of Pharmacy, Columbia, SC. Jamie is a medical reviewer for NiceRx.

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The content on this website is intended for information purposes only. It does not constitute medical advice. The information on this website should not be relied upon and is not a substitute for professional medical advice. You should always speak to your doctor regarding the risks and benefits of any treatment.