Denosumab (brand name Prolia) is a medication used to treat severe osteoporosis. It works by turning off the natural process of breaking down and reabsorbing bones. It is administered through a shot twice per year for up to 10 years. Denosumab has proven effective at building bone density and reducing spine and hip fractures. However, it carries a risk of serious side effects. People with weakened immune systems are advised not to use to denosumab because it can lead to serious infections that require hospitalization (such as heart infections). It can also cause disintegration of the jaw, called osteonecrosis, and atypical femur fractures. The NWHN is concerned that for most postmenopausal women, the benefit of denosumab does not outweigh the risks. We recommend that women seeking osteoporosis treatment approach denosumab with caution.
Common osteoporosis treatment plans with denosumab also include follow up treatments with medication like abisphosphonate which slows the rate of bone loss. This is because the bone-density building benefits of denosumab are lost quickly after you stop taking the medication if you do not follow up with a few years of a medication like bisphosphonates.
Recent studies have shown that people who stop taking denosumab experience bone loss within the first year if they do not start taking a new osteoporosis treatment. Clinical trials have demonstrated a rapid decrease in bone mineral density (BMD) and an increase in bone turnover markers (BTMs). Both BMD and BTMs are indicators used to diagnose osteoporosis. In clinical trials, results also suggest that people who stop taking denosumab and did not start another treatment experienced more vertebral fractures (fractures in your spine) in the 10 months after treatment than people who had been taking a placebo. For these reasons, pausing your treatment or taking a “drug holiday” is not recommended when taking denosumab. Researchers and physicians recommend that you do not stop taking denosumab without making a plan for further bone treatment.
For more information check out our Osteoporosis Treatment Fact Sheet.