How Long Should You Wait After Interview Before Contacting Again
How long can you take Prolia injections and are there any risks of discontinuing Prolia? What are the Prolia side effects and how long do Prolia side effects last? Can you stop taking Prolia? These are some of the questions individuals struggle with when a physician recommends Prolia.
Many of the patients at my physiotherapy clinic are either taking Prolia injections or considering Prolia to treat their osteoporosis. While the decision to use Prolia is best left to the physician and patient, many of my patients leave their physician's office with unanswered questions. I wrote this article to address these questions.
[Disclosures: I have no affiliation or relationship (commercial or otherwise) with Amgen — the manufacturer of Prolia. I receive no direct financial or other compensation for this article.]
This article was last updated on September 23, 2021
Prolia Questions
The most common questions that I hear from patients and readers of this blog are:
- How does Prolia work?
- How long can you take Prolia?
- How to discontinue Prolia?
- What are the side effects (and potential dangers) of taking Prolia?
- How long do Prolia side effects last?
- Can Prolia side effects be reversed?
- How long does Prolia stay in the body or system?
In order to answer these questions thoroughly, I consulted a number of leading experts on Prolia, delved into the latest independent scientific material on Prolia, and conducted a detailed review of Amgen's (the manufacturer of Prolia) website. The article reflects the latest publicly available information on Prolia.
Objective of This Article
The objective of this article is to provide you with the information you need to have an intelligent and informed discussion with your physician regarding Prolia as a pharmaceutical treatment for osteoporosis.
After reading this article, you will be in a better position to speak to your physician and decide whether Prolia is right for you or whether you should discontinue Prolia shots.
I have tried to provide a fair assessment of the efficacy of Prolia based on available clinical experience and scientific evidence. I discussed many of the questions associated with Prolia directly with three established experts in the field. These experts are from a wide range of backgrounds including two physicians with direct clinical experience (Dr. Adachi and Dr. Gonzalez-Rodriguez), a recognized researcher (Dr. Gonzalez-Rodriguez), and a clinical pharmacist with over 40 years of experience treating women and men with osteoporosis (Kent MacLeod).
If you are starting Prolia treatment or planning to discontinue Prolia, you should go through this article carefully and consult with your physician.
Before We Start Discussing Prolia
Prolia can be a controversial topic to discuss so I want to make a few points before we start.
First, I am a Physical Therapist who treats patients with osteoporosis, osteopenia and low bone density. Invariably, many of these patients are taking an osteoporosis pharmaceutical, with many of these taking Prolia shots.
Although I do not prescribe medication, I feel it is important that I understand the implications of pharmaceutical intervention when treating my patients.
Second, the article is designed to equip you, the reader, with the information you need to discuss the right pharmaceutical route for you, especially as it pertains to Prolia.
I do not offer advice as to whether you should start, stop, restart or replace Prolia. That is something you have to discuss with your physician. After reading this article, you can have an informed conversation with your physician and arrive at a well-considered and thoughtful decision, one that is right for you.
Third, I have no affiliation or relationship (commercial or otherwise) with Amgen — the manufacturer of Prolia. I receive no direct financial or other compensation for this article. The article was prepared for you so that you can make a good decision about your health.
Sources for Information on Prolia
While preparing this article, I consulted a number of experts with significant clinical and research experience using Prolia.
Dr. Jonathan Adachi
To gain an understanding on the clinical use of Prolia, I consulted Dr. Jonathan Adachi. Dr. Adachi manages a rheumatology practice at St. Joseph's Healthcare in Hamilton, serves as Actavis Chair for Better Bone Health in Rheumatology, and teaches at the Department of Medicine at McMaster University.
Dr. Adachi is currently involved in the CIHR funded Canadian Multicentre Osteoporosis Study. He is a past president and member of the Scientific Advisory Council of Osteoporosis Canada, was a member of the Council of Scientific Advisors of the International Osteoporosis Foundation (IOF), and was a member of the IOF Board of Directors.
In addition to contributing to this article, Dr. Adachi kindly reviewed the post in its entirety and suggested changes and fixed errors.
Dr. Elena Gonzalez-Rodriguez
To gain a better understanding of the implications of discontinuing Prolia, I consulted Dr. Elena Gonzalez-Rodriguez. Dr. Gonzalez-Rodriguez is a physician and a clinical expert in the area of osteoporosis with the Centre Hospitalier Universitaire Vaudois (CHUV) in Lausanne, Switzerland. She is the author of a recent study on Prolia discontinuance.
Dr. Gonzalez-Rodriguez has published numerous papers on the discontinuation of Prolia, many of them cited in this article.
Kent MacLeod, Clinical Pharmacist
Clinical Pharmacist Kent MacLeod provided a detailed explanation of how Prolia works. Kent is the CEO and founder of NutriChem Compounding Pharmacy and Clinic in Ottawa.
In addition to the interviews mentioned above, I reviewed a number of recent research articles on Prolia. Later in the article, I provide a list of research articles I used.
Finally, I performed a careful read of the Prolia literature on Amgen's website. That material is referenced in the article.
Key Takeaways on Prolia
Here is an executive summary of the key points made in this Prolia article.
- Consult with your physician when and if you should take Prolia injections. Have a conversation with your physician about Prolia. You can use the talking points listed the section below entitled, Prolia and Your Doctor.
- A key question patients struggle with is how long can you take Prolia? If you start Prolia injections, you should plan on being on the treatment for life. Discontinuing Prolia usage (without going onto another pharmaceutical to maintain the gains you made) could have serious, irreversible side effects. These side effects include multiple vertebral compression fractures and a lowering of your bone mineral density.
- You should work with your physician on an exit plan if you decide to stop using Prolia. Keep in mind that the medical community is still working on the most appropriate and safe way to discontinue Prolia. I discuss these in detail in this article.
- If you are at a high risk of osteoporosis fracture and your physician advises Prolia injections, you should consider following her or his advice.
- Prolia need not be the treatment of choice if your diagnosis places you in a low or moderate fracture risk category. The right combination of exercise and good nutrition can help you to stay (or move you into) the low risk fracture risk category. With the support of your physician, you should try to delay Prolia injections.
- Prolia injection side effects can happen. However, both Dr. Adachi and Amgen state that serious side effects are rare. Dr. Adachi's experience is that most side effects last a short time (less than 3 months), and many Prolia side effects can be treated and reversed.
Prolia and Your Doctor
Review this article in its entirety before you meet with your physician to discuss Prolia. You should explore the following topics when you meet with your doctor:
- Make sure that your physician is confident that Prolia is the right treatment for you — at this time in your life. Do you have the right fracture risk profile? Are there other options you can pursue that allow you to delay the time you start Prolia?
- If you experience serious side effects, what is the plan to discontinue Prolia shots and transition to another pharmaceutical treatment?
- Can your physician refer you to a Physical Therapist who can construct an osteoporosis exercise program for you that reduces your risk of a fall and chance of a fracture?
- Ask your physician to refer you to a Nutritionist who can review your diet to determine you are getting adequate bone building nutrients?
- I encourage you to speak with your dentist about any possible dental work that needs to be done before you start on Prolia or a bisphosphonate therapy.
Sudden Stop of Prolia Shot
In the video, above, I discuss a recent study out of Switzerland that indicates that a sudden stop in the usage of Prolia (often because your Physician sees that the medication has been very effective) could lead to incidence of compression fracture. This development could have an impact on how long can you take Prolia.
Later in this article is a detailed update on a new systematic review by the European Calcified Tissue Society (ETCS) on the possible outcomes of discontinuing a Prolia injection treatment program. I also discuss recent developments on potential ways to discontinue Prolia without increasing fracture risk.
Exercise Recommendations for Osteoporosis
Whether you take Prolia or not, therapeutic exercise needs to be part of your osteoporosis treatment program. Exercise is an essential ingredient to bone health.
But what exercises should you do and which ones should you avoid? What exercises build bone and which ones reduce your chance of a fracture? Is Yoga good for your bones? Who should you trust when it comes to exercises for osteoporosis?
A great resource on exercise and osteoporosis is my free, seven day email course called Exercise Recommendations for Osteoporosis. After you provide your email address, you will receive seven consecutive online educational videos on bone health — one lesson each day. You can look at the videos at anytime and as often as you like.
I cover important topics related to osteoporosis exercise including:
- Can exercise reverse osteoporosis?
- Stop the stoop — how to avoid kyphosis and rounded shoulders.
- Key components of an osteoporosis exercise program.
- Key principles of bone building.
- Exercises you should avoid if you have osteoporosis.
- Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
- Core strength and osteoporosis — why is core strength important if you have osteoporosis?
Enter your email address and I will start you on this free course. I do not SPAM or share your email address (or any information) with third parties. You can unsubscribe from my mail list at any time.
How Does Prolia Works
In this section, I define Prolia, explain how it works, discuss how Prolia builds bone, identify Prolia dosage levels, and compare Prolia to another osteoporosis medication, bisphosphonates.
What is Prolia and How Does Prolia Work?
Kent McLeod, pharmacist and owner of NutriChem Pharmacy, defines Prolia as an immunoglobulin monoclonal antibody — a glycoprotein that interferes with the protein RANK ligand (RANKL) and prevents the formation, maturation and survival rates of osteoclasts. RANKL is the molecule blocked by denosumab. (1)
Prolia influences the bone remodelling process by binding to these cells that become osteoclasts. This binding effect leads to the death of the osteoclasts and thus stops bone breakdown.
Osteoclast numbers are greatly reduced and there is virtually no resorption for several months after a Prolia injection.
Dr. Adachi summarized how Prolia works by explaining that:
"Prolia affects bone by inhibiting osteoclast precursor cell maturation and osteoclast function."
Prolia attaches to lymphocytes but does not affect their function. An intact lymphocyte function is an important part of our immune function.
Does Prolia Build Bone?
A number of a research studies demonstrate that Prolia does build bone. In fact, it is more effective at building bone compared to bisphosphonates (I discuss this in more detail later in the post).
In some individuals, Prolia injections have been shown to increase bone mineral density (BMD) by 20%. A 20% increase in bone density is significant. This means that if you had severe osteoporosis with a T score of -3.5 and were treated with Prolia, you might see your T score improve to -1.5.
[Read our FRAX Calculator and Score Interpretation article to learn more about T score.]
Dr. Jonathan Adachi — a leading osteoporosis physician at St. Joseph's Healthcare in Hamilton, Ontario — points at research that shows a 70% reduction in spine fractures and a 40% reduction in hip fractures after three years of Prolia usage.
A study published in 2017 (2) by a team of Japanese researchers looked at the effect of denosumab (Prolia) on bone mineral density and bone turnover markers in Japanese postmenopausal women with osteoporosis.
(Denosumab is the medical term for the human monoclonal antibody medication, while Prolia is the name trademarked by Amgen. They are one and the same thing and I use them interchangeably in this article.)
The team examined the efficacy of three doses of Prolia over a 12 month period compared to a placebo. They reported that "denosumab (Prolia in 14, 60, and 100 mg doses) showed significant increases in percent BMD (bone mineral density) values of lumbar spine and total hip from baseline in 12 months. Distal 1/3 radius BMD (bone mineral density) was also significantly increased except at the 100-mg dose."
They concluded that "Denosumab (Prolia) [in 60 mg doses] could be an effective dose for Japanese postmenopausal women with osteoporosis, as was shown in the Caucasian population."
Prolia, Bone Density and Bone Quality
Prolia treatment increases bone density but there is no evidence that it influences bone quality. (I encourage you to read my article on bone quality to learn about that important bone health topic.)
Bone quality is influenced by a number of factors such as appropriate exercise and hormonal balance. Hormones are the only prescription medication that have a positive influence on bone quality. (3)
Should You Take Prolia for Osteoporosis Treatment?
Asked how he decides who should be prescribed Prolia, Dr. Adachi stated that Prolia should be instituted if the patient is at high risk for fracture.
In his opinion, it is the best available medication for the treatment of osteoporosis. In fact, there is data going out ten years showing that ongoing Prolia treatment leads to sustained benefit for the patient.
He also mentioned that there are patients who are so afraid of Prolia side effects that they refuse to take Prolia or other medications. The unfortunate result is that some patients go on to experience a fracture.
In other words, sometimes the side effects of not taking Prolia exceed the side effects of taking Prolia.
Prolia Injection and Recommended Dosage
The Endocrine Society, the world's largest and most established organization of endocrine clinicians and scientists, recommends a dosage of 60 mg of Prolia every 6 months.
The medication is administered via subcutaneous injection. The injection locations include the upper arm, upper thigh and the abdomen.
Endocrine Society 2019 Recommendations on Prolia Usage
In March of 2019, the Endocrine Society released clinical recommendations on the use of Prolia. The report, entitled Pharmacologic Management of Osteoporosis in Postmenopausal Women, include the following recommendations:
- Postmenopausal women with osteoporosis who are at high risk for osteoporotic fractures should use denosumab (Prolia) as an alternative initial treatment.
- Administration of denosumab should not be delayed or stopped without subsequent antiresorptive (e.g., bisphosphonate, hormone therapy or selective estrogen receptor modulator) or other therapy administered in order to prevent a rebound in bone turnover and to decrease the risk of rapid bone mineral density loss and an increased risk of fracture.
This thinking is consistent with that of Dr. Adachi. He indicates that if Prolia is effective, there is no reason to discontinue the treatment.
If, on the other hand, there is a reason to discontinue Prolia, the termination should not be sudden and a clear alternative treatment plan should be in place.
Who is the Manufacturer of Prolia?
Amgen is the manufacturer of Prolia. It is an American biopharmaceutical company headquartered in Thousand Oaks, California.
Who Should be Prescribed Prolia?
Amgen states that Prolia is for the treatment of low bone mass in:
- Women diagnosed with postmenopausal osteoporosis (and a high risk for fracture) or receiving adjuvant aromatase inhibitor therapy for breast cancer.
- Men at high risk for fracture due to osteoporosis or receiving androgen deprivation therapy for nonmetastatic prostate cancer.
- Men and women at high risk for fracture from Glucocorticoid-induced osteoporosis.
Is Prolia a Bisphosphonate and How Do The Two Compare?
In some ways, Prolia's mechanism is similar in action to that of bisphosphonates.
Prolia, however, is not a bisphosphonate. It works by binding to RANKL and prevents it from binding to the RANK receptor on osteoclasts and their precursor cells. In doing so, they prevent the activation of these cells and prevent bone breakdown or osteoclastic bone resorption.
As I mentioned in the section above, Prolia is an immunoglobulin — a glycoprotein that works by binding to the cells that become osteoclasts. When they bind to these cells, this leads to the death of the osteoclasts cells and thus stops bone breakdown.
Bisphosphonates, on the other hand, reduce osteoclast activity. This, in turn, leads to a slowdown in the turnover of bone and removal of old bone.
Differences Between Bisphosphonates and Prolia
A bisphosphonate, like Prolia, is a medication for the treatment of osteoporosis (Actonel™, Fosamax™, etc). However, bisphosphonates differ from Prolia in four important ways.
1. Effect on Osteoclast Cells
First, Prolia and bisphosphonates differ in how they affect osteoclast cells.
Osteoclast cells are the cleaners of old bone. The newly formed osteoclast cells join mature osteoclasts to perform an important role: the breakdown of the old bone.
Bisphosphonate medications bind directly to bone at sites of active bone breakdown and are then ingested by osteoclasts. When ingested, the osteoclasts die and bone breakdown is prevented.
Prolia, on the other hand, interferes with the cells that make osteoclasts, thus limiting their production.
2. Prolia, Bisphosphonates and Increase in Bone Density
Second, a number of studies (4, 5) that compare Prolia to bisphosphonates demonstrate that Prolia leads to a greater increase in bone mineral density (BMD) and reduced bone turnover markers (BTM) .
3. Prolia, Bisphosphonates and Reduction of Hip Fracture Rate
In one study from Denmark, Prolia demonstrated similar results in hip fracture reduction rate when compared to the bisphosphonate, Alendronate™. (6)
The research team also performed a cost-effectiveness analysis of the two treatments and found that the ""cost-effectiveness of denosumab (Prolia) treatment compared with alendronate is an argument for prescribing denosumab (Prolia) rather than alendronate to prevent hip fractures."
4. Retention in the Body
Dr. Adachi points out that one major difference between Prolia and bisphosphonates is how long each is retained in the body after discontinuation. Prolia is in the body for approximately five months, whereas bisphosphonates can linger in the body for several years.
Because of Prolia's more robust bone density changes, physicians often transition their patients from a bisphosphonate to Prolia. It is recommended that individuals take a drug holiday from a bisphosphonate after 5 to 7 years.
To learn more about bisphosphonates, please refer to my Bisphosphonates Osteoporosis Guidelines blog post.
Prolia, however, is not as strong a medication as Forteo™ or Evenity™. Forteo™ and Evenity™ will be discussed later in the blog post.
How Long Does Prolia Stay in Your System (Body)?
In our 2020 exchange, I asked Dr. Adachi how long Prolia stays in your system. He stated that Prolia is unlike bisphosphonates that stay in bone for years. Prolia is metabolized in three to four months and within five months it is largely gone from your body.
How Long Can You Take Prolia?
In 2017, after Prolia had been available for a decade, I asked Dr. Jonathan Adachi how long a patient can take Prolia. At that time, Dr. Adachi recommended that patients that start Prolia should continue the treatment for ten years.
Now that we have more experience with Prolia, Dr. Adachi indicates that anyone currently on Prolia should plan on continuing Prolia for life. Once started, Prolia should not be discontinued.
The reason: a sudden stop in usage of Prolia (without a proper termination plan) can have significant irreversible side effects. These irreversible side effects include multiple vertebral fractures and a reduction of your bone mineral density.
Dr. Adachi was clear to point out that if you are unable to continue your Prolia treatments, your physician should have a plan to transition your Prolia injections to another pharmaceutical.
If you decide that you want to either terminate your use of Prolia or take a "drug holiday", you should discuss your concerns with your Physician before making such a move.
Can You Discontinue Prolia?
A sudden discontinuance of Prolia can lead to serious side effects including multiple vertebral fractures and a reduction of your bone mineral density.
Clinicians and researchers have found that a sudden termination of Prolia can result in a "rebound effect" that could lead to further bone loss and increased risk of fractures. (7)
As a result, researchers are investigating how to reduce the risk of a rebound of bone loss and fracture upon discontinuation of Prolia.
Exercise Recommendations for Osteoporosis
Whether you take Prolia or not, therapeutic exercise needs to be part of your osteoporosis treatment program. Exercise is an essential ingredient to bone health.
But what exercises should you do and which ones should you avoid? What exercises build bone and which ones reduce your chance of a fracture? Is Yoga good for your bones? Who should you trust when it comes to exercises for osteoporosis?
A great resource on exercise and osteoporosis is my free, seven day email course called Exercise Recommendations for Osteoporosis. After you provide your email address, you will receive seven consecutive online educational videos on bone health — one lesson each day. You can look at the videos at anytime and as often as you like.
I cover important topics related to osteoporosis exercise including:
- Can exercise reverse osteoporosis?
- Stop the stoop — how to avoid kyphosis and rounded shoulders.
- Key components of an osteoporosis exercise program.
- Key principles of bone building.
- Exercises you should avoid if you have osteoporosis.
- Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
- Core strength and osteoporosis — why is core strength important if you have osteoporosis?
Enter your email address and I will start you on this free course. I do not SPAM or share your email address (or any information) with third parties. You can unsubscribe from my mail list at any time.
Prolia Discontinuance
A group of clinicians in Switzerland and a working group of clinicians and researchers from the European Calcified Tissue Society (ETCS) have explored the possible implications of discontinuing Prolia osteoporosis treatment (8).
Reasons to Discontinue Prolia
In their 2019 research publication, Lamy, Gonzalez-Rodriguez and colleagues (9) identify several clinical reasons to stop Prolia.
- Women who are treated for breast cancer via adjuvant AI (aromatase inhibitors) therapy often take Prolia for bone preservation reasons. When the AI therapy terminates, Prolia is supposed to be discontinued.
- Some physicians discontinue Prolia when the patient achieves the target T-Score that places them outside the osteoporosis category. This could lead to multiple vertebral compression fractures and a lowering of your bone mineral density, and should be avoided.
- In some rare cases, the risk of osteonecrosis of the jaw (ONJ) and atypical femoral fractures increases with Prolia treatment. If this happens, the risk of ONJ and atypical fractures potentially exceeds the benefits of Prolia.
Potential Risks of Discontinuing Prolia Injections
The potential risks of discontinuing Prolia injections treatment include an increased risk of fracture, including compression fractures. Two recent research studies shed some light on this question.
In the first study, the researchers noticed that when people came off of Prolia (within nine to sixteen months of discontinuing Prolia), they experienced numerous compression fractures.
In the second study, the researchers noticed an increased risk of multiple vertebral fractures after discontinuation of Prolia.
I cover the two studies in detail next.
Prolia Injection Discontinuance Results • 2016
In the Spring of 2016, a research team from Switzerland presented case studies (10) from their practice at the annual Endocrinology Conference. In the case studies, seven women had been put on Prolia.
Some of the women had just received two to four Prolia injections. They were not on Prolia for very long because shortly after starting Prolia, their doctor noticed the improvement in bone density. The physician prematurely, and without realizing the consequences, discontinued the Prolia injection treatments.
The researchers noticed that when people came off of Prolia (within nine to sixteen months of discontinuing Prolia), that they fractured and experienced numerous compression fractures.
The paper indicated that the seven women, mentioned above, had 28 fractures in total between them.
When they presented an updated version of the paper a half-a-year later in the Fall of 2016, they stated that there were nine women, with on average, five-and-a-half fractures per individual.
This indicates that bone density gains experienced during Prolia treatment should not be a reason to prematurely terminate Prolia. You should discuss this with your physician if the topic of discontinuance surfaces.
Prolia Injection Discontinuance • 2018 Follow On Report
In 2018, the Swiss research team (above) reported on the cases of 35 patients (34 women and one man between the ages of 66 and 76) who received 60 mg doses of Prolia every six months. The total number of doses ranged between two to eleven total doses. (11)
All of the patients used both calcium and Vitamin D during the time they were receiving Prolia, as well as after the discontinuance of the Prolia injections.
The research team reported the following:
- After Prolia discontinuation, women below the age of 65 years had a higher number of spontaneous clinical vertebral fractures (SCVF) and in a shorter period than women over 65 years.
- SCVF are a very severe and frequent clinical complication after Prolia discontinuation.
- Bisphosphonates may decrease the rebound effect at Prolia discontinuation.
Prolia Discontinuation and Fracture Risk
At the September 2018 American Society for Bone and Mineral research (ASBMR) conference in Montreal, I asked Dr. Elena Gonzalez-Rodriguez — a researcher and physician in the area of osteoporosis — two questions I often get from my patients:
- Can you stop taking Prolia?
- What happens if you stop taking Prolia?
Dr. Gonzalez-Rodriguez is the author of the study, Is Denosumab Discontinuation Associated with a Severe Increase in Fracture Risk? (12)
She identified two separate circumstances for the patient to consider:
- The period after they have had only one Prolia shot.
- After they have had more than one Prolia shot.
The answer is very different under each circumstance.
Can You Stop Taking Prolia if You Have Had Only One Prolia Injection?
I asked Dr. Gonzalez-Rodriguez what do you tell someone who has changed their mind after they receive their first Prolia injection? I also asked her if a patient can stop taking Prolia without undesirable consequences.
Dr. Gonzalez-Rodriguez indicated that the choice for an osteoporotic treatment has to be taken by the physician and the patient. If Prolia treatment is discontinued after a single injection, Dr. Gonzalez-Rodriguez states that all scientific evidence suggests that there is no risk for biological, densitometric or clinical (vertebral fractures risk) rebound.
In 2017, I asked Dr. Adachi the same question. Dr. Adachi stated:
"You can probably discontinue the Prolia treatment after a single dose. However, if they have started Prolia there must have been a good reason for terminating the treatment. Stopping any drug after one injection, or a couple of weeks of bisphophonate treatment, is going to leave them at risk for fracture because their osteoporosis status will not have changed."
Can You Stop Taking Prolia if You Have Had More Than One Prolia Injection?
I asked Dr. Gonzalez-Rodriguez what she tells someone who has received two or more Prolia injections and wants to stop. Is it possible for them to stop taking Prolia without undesirable consequences?
She stated that once a patient received two or more Prolia injections, there is a risk of the rebound effect (i.e., rapid bone loss and increased risk of fracture) at the discontinuation of Prolia. As far as it is known, there is no difference between the rebound effect after two or more injections.
Dr. Gonzalez-Rodriguez stated that if Prolia is well-tolerated and the treatment indication is clear, there is no reason to stop Prolia treatment because of the existence of the rebound effect.
Like Dr. Adachi, she further stated that Prolia is a very efficacious treatment, and once initiated with two or more injections, the patient should take advantage of its benefits.
Dr. Gonzalez-Rodriguez concluded by stating that it is very important for patients that Prolia injections are strictly given every six months, and that no Prolia injection is missed.
If you decide to stop Prolia, it should always be done in a controlled manner. There should be very close follow up by the treating physician who will explain to the patient the protocol to be followed.
Can You Avoid Bone Loss and Fracture After Stopping Prolia?
A number of women have contacted me and stated that they have sustained multiple vertebral fractures after they have been removed from Prolia.
In light of reported findings from small studies, such as the one presented at the European League Against Rheumatism (EULAR), that looked at the best approach to transition someone off of Prolia, I asked Dr. Adachi what he recommends for the discontinuation of Prolia.
He emphasized that "Prolia should not be discontinued. [However] if they need to discontinue Prolia treatment, I would start a bisphosphonate around five months after the last Prolia shot or injection."
A recent analysis (13) presented at the Annual European Congress of Rheumatology (EULAR 2019) demonstrated promising results from bisphosphonate use.
The team found that women who had received an infusion of zoledronate, an intravenous bisphosphonate, before starting Prolia and after discontinuing Prolia, had a better chance of maintaining the bone density gained during the Prolia phase of their treatment.
Bisphosphonate Infusion Therapy and Prolia
A study (14) presented at the European League Against Rheumatism conference in Madrid, Spain in June of 2019, indicated that an injection of an infusion bisphosphonate, zolendronic acid (Reclast®), before or after the Prolia treatment protocol could offset the rebound effects associated with sudden Prolia discontinuance.
The research team found that "denosumab (Prolia) withdrawal without subsequent bisphosphonate treatment seems to be related to a rebound effect: a rapid decrease in mineral density in bone densitometry (DEXA)."
The team stated in their conclusion that "denosumab (Prolia) withdrawal without subsequent antiresorptive treatment produces a rapid decrease in [bone mineral density] DEXA values in our patients. This phenomenon appears to diminish in patients who have received denosumab (Prolia) for a longer period."
Transitioning Off of Prolia to a Bisphosphonate
In the past, Dr. Adachi mentioned that an oral bisphosphonate should be prescribed once someone is taken off of Prolia. A bisphosphonate could reduce the possibility of a fracture risk.
During my 2020 exchange with Dr. Adachi, I referenced the studies mentioned above and asked if he preferred an oral bisphosphonate (like Fosamax or Actonel ) or the injectable bisphosphonate (such as zolendronic acid).
He responded by stating that he "[uses] Actonel DR as it is covered by the Ontario government, and may be taken with food."
(Please note that Dr. Adachi is referring to medical coverage provided by the government of Ontario and that the insurance coverage in your jurisdiction will likely differ.)
He went on further to say that "the problem with an IV bisphosphonate is that it has more side effects and is more difficult to set up."
Zolendronic and Prolia
In May 2020, a Danish research team published a study (15) that "investigated if treatment with zoledronate could prevent bone loss (after Prolia discontinuance) and if the timing of the zoledronate infusion influenced the outcome."
Dr. Anne Sophie Soelling of Aarhus University Hospital in Denmark and her team ran the trial for a two year period. Sixty-one postmenopausal women and men who discontinued Prolia after six years of treatment were selected for the trial.
The participants were randomly assigned to two groups. The first group received a single injection of zoledronate six months and the second group received a single injection of zoledronate nine months after the most recent Prolia injection or "when bone turnover had increased beyond a certain threshold".
A third observational group was used in the study for comparative purposes.
Dr. Soelling used DEXA scores and bone turnover markers to track the participants bone health. Fifty-nine of the original sixty-one participants completed the trial.
Findings: Zolendronic and Prolia
The trial found that there was significant loss of bone mineral density (BMD) reported for all groups.
- The loss at the lumbar spine was 30% in the six-month cohort and 45% in the nine-month cohort. The observational group experienced a 47% decline.
- Bone mineral density loss in the hip region occurred in 5% of the six-month group, 25% of the nine-month group, and 11% of the observational group. (16)
The team concluded that "treatment with zoledronate, irrespective of the timing, did not fully prevent loss of BMD in patients discontinuing denosumab (Prolia)."
Dr. Soelling stated that "we speculate that some patients would benefit from a second treatment with zoledronate three to six months later. This needs to be investigated in a clinical trial."
The study has come under some criticism, including that the trial size was too small to make major conclusions and recommendations.
At time of publication, the research team indicated that the study trial was still ongoing.
Multiple Spontaneous Vertebral Fractures
Cases have been reported where physicians have prematurely taken their patients off Prolia only to cause multiple vertebral fractures.
When I asked Dr. Adachi what his pharmaceutical approach would be for someone who was in that situation after prematurely stopping Prolia, he indicated that he would recommend Evenity to the patient.
Prolia Side Effects
In this section, I identify the major and minor Prolia side effects. This section also includes a discussion of recently identified Prolia side effects published on Amgen's website.
To be clear, many people find success with Prolia and experience few, if any, side effects during their course of treatment.
According to Dr. Adachi, Prolia side effects are rare and far fewer than what we see with bisphosphonates, such as alendronate or risedronate.
Dr. Adachi's experience with Prolia side effects is the following:
- Acute symptoms like rash and low blood calcium occur early within the first couple of weeks.
- Long-term side effects like osteonecrosis of the jaw (ONJ) may occur at any time, but are extremely rare.
- Atypical femoral fractures occur when Prolia use is greater than 5 years. He estimates that atypical femoral fractures occur within around 8 years based on clinical experience with bisphosphonates.
In the rare instance where there are Prolia side effects, the patient may experience:
- A rash, itching, blistering or reddening of skin.
- Hives.
- Bone, joint, back or muscle pain (myalgias).
- Low blood calcium levels may occur in those with chronic kidney disease or malabsorption. As a result, your physician may encourage you to increase your vitamin D and calcium intake while you are being treated with Prolia.
- Osteonecrosis of the jaw (ONJ) and atypical femoral fractures may also occur — but these are rare.
- Allergic reaction including low blood pressure; impaired breathing; or swelling in the face, tongue or lips.
- Skin infections or inflammations.
- Difficulty urinating; including pain, burning or irritation while urinating.
- Frequent urge to urinate.
The Mayo Clinic provides a detailed list of Prolia side effects from common to less common.
Exercise Recommendations for Osteoporosis
Whether you take Prolia or not, therapeutic exercise needs to be part of your osteoporosis treatment program. Exercise is an essential ingredient to bone health.
But what exercises should you do and which ones should you avoid? What exercises build bone and which ones reduce your chance of a fracture? Is Yoga good for your bones? Who should you trust when it comes to exercises for osteoporosis?
A great resource on exercise and osteoporosis is my free, seven day email course called Exercise Recommendations for Osteoporosis. After you provide your email address, you will receive seven consecutive online educational videos on bone health — one lesson each day. You can look at the videos at anytime and as often as you like.
I cover important topics related to osteoporosis exercise including:
- Can exercise reverse osteoporosis?
- Stop the stoop — how to avoid kyphosis and rounded shoulders.
- Key components of an osteoporosis exercise program.
- Key principles of bone building.
- Exercises you should avoid if you have osteoporosis.
- Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
- Core strength and osteoporosis — why is core strength important if you have osteoporosis?
Enter your email address and I will start you on this free course. I do not SPAM or share your email address (or any information) with third parties. You can unsubscribe from my mail list at any time.
How to Reverse Prolia Side Effects
Dr. Adachi recommends a small amount of prednisone to reduce the duration of a rash or myalgias that results from Prolia shots.
Secondly, he mentioned that if your calcium levels drop, you can increase your vitamin D and calcium intake while you are being treated with Prolia.
How Long Do Prolia Side Effects Last?
According to Dr. Adachi, in the rare cases when they occur, Prolia side effects last up to three months. They do not persist for more than five months (the length of time Prolia is in your body).
In general, the vast majority of Prolia side effects are resolved within three months. Acute symptoms like rash and low blood calcium occur early within the first couple of weeks.
If you are experiencing an acute symptom that you believe to be a Prolia side effect and it persists for longer than three to six months, you should consult with your physician.
Keep in mind that the condition you are experiencing might not be related to your Prolia injection and should be attended to in a timely manner.
Does Prolia Cause Dental Problems?
Long-term side effects like osteonecrosis of the jaw may occur at any time but are extremely rare.
In 2020 I mentioned to Dr. Adachi that I know of individuals who have been asked to discontinue Prolia by their dentist (oral surgeon) to reduce osteonecrosis of the jaw. I asked Dr. Adachi how long you should wait after oral surgery before your next Prolia shot.
To avoid any complications, Dr. Adachi stated that he "typically has the patient do the dental surgery five months after a Prolia shot and then delay the next Prolia injection until the tissue heals. [This often takes] around four to six weeks; at which time I would [continue] the Prolia shots again."
Prolia's Effect on the Immune System
I asked Dr. Adachi if he had concerns about Prolia relative to the impact on the immune system.
He stated that there were some initial concerns Prolia could affect the immune system. At that time there were some skin infections that occurred in the Prolia treated group and not in the placebo group.
Time has passed and there is longer term data on Prolia treatment. The ten year data suggest that there is not a long term risk for infection or malignancy.
Further, there does not appear to be an increase in infection risk in the breast cancer population treated with very high doses of Prolia.
In patients with rheumatoid arthritis who are on immunosuppressive therapy and Prolia, clinicians have not reported significant increases in infection.
Prolia and COVID-19
A joint guidance statement issued in May of 2020 by the American Society for Bone and Mineral Research (ASBMR), the American Association of Clinical Endocrinologists, the Endocrine Society, the European Calcified Tissue Society, and the National Osteoporosis Foundation stated that:
"there is no evidence that any osteoporosis therapy (including Prolia) increases the risk or severity of COVID-19 infection or alters the disease course." (17)
Amgen's Prolia Side Effects Warnings and Precautions
In March of 2020, Amgen updated its documentation on Prolia side effects. (18) The company identified ten warnings and precautions in its prescription information sheet. Below I highlight five of the ten that I think are most applicable to the reader.
Multiple Vertebral Fractures
Amgen states in its prescription information sheet that "following [the] discontinuation of Prolia treatment, fracture risk increases, including the risk of multiple vertebral fractures."
This Prolia side effect is becoming known among the medical community. Your physician should be aware that sudden discontinuation of Prolia can be problematic.
Amgen, explains that "treatment with Prolia results in significant suppression of bone turnover and cessation of Prolia treatment results in increased bone turnover above pretreatment values 9 months after the last dose of Prolia. Bone turnover then returns to pretreatment values 24 months after the last dose of Prolia."
Further, it states that "new vertebral fractures occurred as early as 7 months (on average 19 months) after the last dose of Prolia. Prior vertebral fracture was a predictor of multiple vertebral fractures after Prolia discontinuation."
It advises physicians to "evaluate an individual's benefit-risk before initiating treatment with Prolia." In other words, you should expect that your doctor will work with you to fully evaluate whether you are a candidate for this treatment.
Finally, Amgen advises physicians that "if Prolia treatment is discontinued, patients should be transitioned to an alternative antiresorptive therapy."
Bone Remodelling Suppression
Amgen states that clinical trials of postmenopausal women with osteoporosis who were treated with Prolia "resulted in significant suppression of bone remodeling as evidenced by markers of bone turnover and bone histomorphometry."
They indicate that the "significance of these findings and the effect of long-term treatment with Prolia are unknown." It is possible that bone modelling suppression could, over the long term, lead to a number of problems, including:
- Osteonecrosis of the jaw (ONJ).
- Atypical fractures.
- Delayed fracture healing.
Atypical Fractures
Amgen states that "atypical low energy or low trauma fractures of the shaft have been reported in patients receiving Prolia. These fractures can occur anywhere in the femoral shaft from just below the lesser trochanter to above the supracondylar flare and are transverse or short oblique in orientation without evidence of comminution."
This means that you can have a fracture from things as gentle as walking. Fractures can occur anywhere between your knee and your hip. Finally, the fracture may be straight or on an angle and there can be more than one fracture.
Amgen states that the atypical femoral fractures "most commonly occur with minimal or no trauma to the affected area. They may be bilateral, and many patients report prodromal pain in the affected area, usually presenting as dull, aching thigh pain, weeks to months before a complete fracture occurs."
In other words, there can be no apparent reason for the fracture to occur. The first symptoms will be a dull, aching thigh pain that can go on for weeks or months before the bone actually fractures enough that it breaks.
The causality of these fractures has not been determined since "these fractures also occur in osteoporotic patients who have not been treated with antiresorptive agents."
Further, Amgen indicates that a "number of reports note that patients were also receiving treatment with glucocorticoids (e.g. prednisone) at the time of fracture."
Dr. Adachi observes that atypical femoral fractures occur when Prolia use is greater than 5 years. He estimates that atypical femoral fractures occur within around 8 years based on clinical experience with bisphosphonates.
If you experience dull, aching thigh pain anywhere from your knee to your hip, you need to speak to your doctor about this possible side effect. Your physician should order a test to see if you have a hairline fracture and measures should be taken to reduce the risk of it developing into a complete fracture.
Musculoskeletal Pain
The prescription information sheet states that "severe and occasionally incapacitating bone, joint, and/or muscle pain has been reported in patients taking Prolia. The time to onset of symptoms varied from one day to several months after starting Prolia."
Amgen advises medical professionals to "consider discontinuing (Prolia) use if severe symptoms develop."
Besides the uncomfortable sensations associated with this pain, this side effect can limit your desire to exercise and move, at a time when you need to maintain an exercise program that promotes balance, posture, strength and overall well-being.
Hypocalcemia
Hypocalcemia is a medical condition in which the patient experiences lower-than-average levels of calcium in their blood. Dr. Adachi mentioned this side effect earlier in the post.
The prescription information sheet states that "hypocalcemia may be exacerbated by the use of Prolia."
Amgen suggests that physicians take the following steps:
- Pre-existing hypocalcemia must be corrected prior to initiating therapy with Prolia.
- Clinical monitoring of calcium and mineral levels (phosphorus and magnesium) is highly recommended within 14 days of Prolia injection for patients predisposed to hypocalcemia and disturbances of mineral metabolism.
- Adequately supplement all patients with calcium and vitamin D.
Prolia, Forteo and Evenity
In this section, I discuss Prolia in the context of two other osteoporosis pharmaceuticals, Forteo and Evenity. I also cover the link between PPI's and fragility fractures.
Difference Between Forteo and Prolia
Teriparatide (or Forteo) is an anabolic agent, a drug that builds bone. Denosumab (or Prolia) is an antiresorptive drug, one that prevents the breakdown of bone.
Here is a summary of the differences between Forteo and Prolia:
- Patients with multiple fractures with very low bone density use Forteo.
- If you have undergone radiation therapy or who have Paget's disease, you should not use Forteo.
- Prolia should be used with caution in those who have low calcium levels. These are usually seen in individuals with malabsorption or severe renal disease.
- Forteo is given daily for two years and Prolia every six months via subcutaneous injection for life.
In the short term, Forteo is more expensive than Prolia.
EVENITY
In October 2019 Health Canada approved a third potent bone-building drug for the treatment of individuals who are at a high risk of fracture, Evenity.
In April of 2020, I asked Dr. Adachi how he decides when a patient should take Denosumab (Prolia) instead of Teriparatide (Forteo) or Romosozumab (EVENITY).
Dr. Adachi stated that
"Forteo is the most expensive [osteoporosis medication] and it is hard to get private insurance to cover its cost. Evenity is less expensive and has more private coverage but does not have public funding by the government (of Ontario or Canada). Prolia is covered by both private and government insurance programs. EVENITY provides the greatest increase in bone mineral density (BMD)."
To learn more about EVENITY, please read (and listen to) my interview with endocrinologist Dr. Janet Rubin.
Link Between PPI's and Fragility Fractures
Many people are on proton pump inhibitors (PPI's) for gastroesophageal reflux. There are a few studies that tenuously establish a link between PPI's (such as Nexium) and fragility fractures.
I asked Dr. Adachi what he tells his clients who are on PPI's. Should they increase their calcium intake?
There is evidence that there may be an association between PPI's and fractures. This remains controversial. If they are taking the PPI intermittently, it is probably less of a concern.
However if they require high doses of their PPI, Dr. Adachi suggests that they increase their dietary calcium intake so that they get three to four dairy products a day.
If they have osteoporosis and are at high risk for fractures or have had fractures, Dr. Adachi recommends treatment with either a bisphosphonate or Prolia.
Exercise Recommendations for Osteoporosis
Whether you take Prolia or not, therapeutic exercise needs to be part of your osteoporosis treatment program. Exercise is an essential ingredient to bone health.
But what exercises should you do and which ones should you avoid? What exercises build bone and which ones reduce your chance of a fracture? Is Yoga good for your bones? Who should you trust when it comes to exercises for osteoporosis?
A great resource on exercise and osteoporosis is my free, seven day email course called Exercise Recommendations for Osteoporosis. After you provide your email address, you will receive seven consecutive online educational videos on bone health — one lesson each day. You can look at the videos at anytime and as often as you like.
I cover important topics related to osteoporosis exercise including:
- Can exercise reverse osteoporosis?
- Stop the stoop — how to avoid kyphosis and rounded shoulders.
- Key components of an osteoporosis exercise program.
- Key principles of bone building.
- Exercises you should avoid if you have osteoporosis.
- Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
- Core strength and osteoporosis — why is core strength important if you have osteoporosis?
Enter your email address and I will start you on this free course. I do not SPAM or share your email address (or any information) with third parties. You can unsubscribe from my mail list at any time.
Should You Take Prolia?
A key question for many patients, besides how long can you take Prolia, is should I take Prolia at all? This is a complex question and I strongly suggest you discuss this with your physician.
Many women do not make their bone health a priority until a life event, such as a diagnosis of osteoporosis, forces a change. They often find that their physician recommends that they take an osteoporosis medication such as Prolia, Evenity or Prolia.
The decision to take an osteoporosis medication, such as Prolia, is an important health decision that you should discuss with your Physician.
The following story is about a patient of mine who was in a position to hold off on Prolia injections because she was in a low fracture risk category.
Nina Completes a Bone Mineral Density Test
Nina (not her real name or picture) schedules her annual physical around her birthday. This year, she turned sixty-five and her physician recommended she have a bone mineral density (BMD) test.
When the results came back, they showed that Nina's bone density was lower than anticipated. As a result, her physician suggested she take Prolia to increase her bone density and reduce her risk of a fracture.
Is Osteoporosis Medication Right for Nina?
Nina had reservations about taking the pharmaceutical route. She did some research and found that although the osteoporosis medications claimed to increase bone density, there were some side effects that made her uncomfortable.
Pharmaceuticals may be appropriate for individuals in urgent need of an increase in bone density because they are at an elevated or high risk of fracture.
However, Nina knows that pharmaceuticals will not improve her bone quality, her balance or strength, and will certainly not reduce her risk of a fall.
Also, since Nina is still at a low risk of a fracture and has many years ahead of her, she decided that the best route was to commit to a program of exercise and nutrition that, as best she could, keep her in the low risk category.
A Plan to Reduce Fracture Risk
Nina asked me to provide her a safer, healthier approach to strengthen her bones and reduce her fracture risk.
After reviewing her bone mineral density test and her current exercise routine, I recommended that Nina incorporate more weight bearing in her exercise program.
As a result, Nina exchanged some of her swimming sessions for other activities such as brisk walking, hiking, and step classes.
Bone Quality
Research into bone strength has found that it is not only the density of bone that determines the strength of bones but also the quality of bones. Safe, frequent loading of bones through strength training (lifting something heavy enough so that the pull from the muscle demands a response from your bones) as well as weight bearing, positively impacts bone quality.
While osteoporosis pharmaceuticals do a good job of building bone density, exercise does a better job of improving bone quality. And as an added benefit, exercise only has positive side effects!
Micro and Macro Trauma Guidelines
One key recommendation I make for many clients is that to avoid a macro trauma to their bones, they need to improve their balance. I also recommend that they work on their posture and modify their movements (during activities of daily living) to avoid a micro trauma to their spine.
Improve Agility with Balance Exercises
I also recommended that Nina improve her balance. Her bone density was low and she needed good balance and strength to regain her footing in case of a trip or slip.
Activities of Daily Living and Nutrition
We also needed to change the way Nina moved when she performed daily activities such as housework and gardening. Proper movement and postural alignment play a key role in preventing spinal fractures.
Nina had to practice mindfulness and relearn how she did her day-to-day activities.
Finally, Nina needed to optimize her food choices to ensure that she had all the essential nutrients needed for her muscles and bones.
Take Control of Your Bone Health
The balance and strength training, her improved body awareness during her daily activities, and her nutrition program have made Nina feel more confident and in control of her bone health. Plus she has made a commitment to keep her bones healthy and in the low risk fracture category.
Prolia Shot Conclusion
This article answers many questions patients have about Prolia, including how long can you take Prolia. We also explored other topics related to the use of Prolia. We provided a definition of Prolia and we compared Prolia to Forteo, Evenity and bisphosphonates.
I encourage you to review this article before you meet with your physician to discuss Prolia. You should explore the following topics when you meet with your doctor:
- Make sure that your physician is confident that Prolia is the right treatment for you — at this time in your life. Do you have the right fracture risk profile? Are there other options you can pursue that allow you to delay the time you start Prolia?
- If you experience serious side effects, what is the plan to discontinue Prolia shots and transition to another pharmaceutical treatment?
- Can your physician refer you to a Physical Therapist who can construct an exercise program for you that reduces your risk of a fall and chance of a fracture?
- Can your physician refer you to a Nutritionist who can review your diet to determine you are getting adequate bone building nutrients?
- I encourage you to speak with your dentist about any possible dental work that needs to be done before you start on Prolia a bisphosphonate therapy.
I want to thank Dr. Jonathan Adachi, Dr. Gonzalez-Rodriguez and Kent MacLeod for taking time to address these questions in detail.
References
References for this article on how long can you take Prolia and how long do Prolia side effects last:
- Per Aspenberg, Denosumab and atypical femoral fractures. Acta Orthopaedica. 2014 Feb; 85(1): 1. Published online 2014 Feb 25. doi: 10.3109/17453674.2013.859423
- Nakamura T, et al. Dose-response Study of Denosumab on Bone Mineral Density and Bone Turnover Markers in Japanese Postmenopausal Women With Osteoporosis. Osteoporos Int. 2012 Mar;23(3):1131-40. doi: 10.1007/s00198-011-1786-8. Epub 2011 Sep 17.
- Fatemeh Abdi, et al. The Effects of Transdermal Estrogen Delivery on Bone Mineral Density in Postmenopausal Women: A Meta-analysis. Iran Journal of Pharmaceutical Research. 2017 Winter; 16(1): 380–389.
- Benjamin B, Benjamin MA, Swe M, Sugathan S. Review on the comparison of effectiveness between denosumab and bisphosphonates in post-menopausal osteoporosis. Osteoporos Sarcopenia. 2016;2(2):77-81.
- Lin T, Wang C, Cai XZ, et al. Comparison of clinical efficacy and safety between denosumab and alendronate in postmenopausal women with osteoporosis: a meta-analysis. Int J Clin Pract. 2012;66(4):399-408
- Pedersen, AB, et al. Comparison of Risk of Osteoporotic Fracture in Denosumab vs Alendronate Treatment Within 3 Years of Initiation. AMA Netw Open. 2019;2(4):e192416. doi:10.1001/jamanetworkopen.2019.2416
- Lamy, O., Stoll, D., Aubry-Rozier, B., Gonzalez-Rodriguez E. Current Osteoporos Rep (2019) 17: 8. https://doi.org/10.1007/s11914-019-00502-4
- Tsourdi, Elena, et al. Discontinuation of Denosumab Therapy for Osteoporosis: A Systematic Review and Position Statement by European Calcified Tissue Society (ECTS). Bone. Volume 105, December 2017, pp 11 to17.
- Lamy, O. Et al. Stopping Denosumab. Current Osteoporosis Reports. 2019 Feb;17(1):8-15. doi: 10.1007/s11914-019-00502-4
- Lamy O, Gonzalez-Rodriguez E, Stoll D, Hans D, Aubry-Rozier B. Severe Rebound-associated Vertebral Fractures After Denosumab Discontinuation: Nine Clinical Cases Report. J Clin Endocrinol Metab. 2016 Oct 12.
- Aubry-Rozier B, Liebich G, Stoll D, et al. Can we avoid the loss of bone mineral density one year after denosumab discontinuation? The REOLAUS Bone Project: Abstract OP0085
- Gonzalez-Rodriguez E, Stoll D, Aubry-Rozier B, Hans D, Lamy O. Is Denosumab Discontinuation Associated with a Severe Increased of Fracture Risk? about 7 Women with 28 Spontaneous Vertebral Fractures 9 to 16 Months after the Last Dose of Denosumab, Endocrine Society's 98th Annual Meeting and Expo, April 1–4, 2016.
- Ian R. Reid et al, Bone Loss After Denosumab: Only Partial Protection with Zoledronate, Calcified Tissue International (2017). DOI: 10.1007/s00223-017-0288-x
- Irati, Urionaguena & Sandra, P & Gallo, Chinchilla & Hernandez Gomez, Sandra & Garcia-Llorente, Jose & Aizpurua Manso, Izaskun & Vegas Revenga, Nuria. (2019). AB0857 DENSITOMETRY VALUES CHANGE WHEN STOPPING DENOSUMAB. Annals of the Rheumatic Diseases. 78. 1896.1-1896. 10.1136/annrheumdis-2019-eular.4338.
- Soelling AS, et al. Treatment with zoledronate subsequent to denosumab in osteoporosis: a randomized trial. Journal of Bone and Mineral Research. 27 May 2020 https://doi.org/10.1002/jbmr.4098
- Zoledronate After Denosumab Does Not Fully Prevent Bone Loss. MedScape. June 18, 2020.
- JOINT GUIDANCE ON OSTEOPOROSIS MANAGEMENT IN THE ERA OF COVID-19 FROM THE ASBMR, AACE, ENDOCRINE SOCIETY, ECTS & NOF. https://www.asbmr.org/ASBMRStatementsDetail/joint-guidance-on-osteoporosis-management-in-era-o
- Amgen. Highlights of Prescribing Information. https://www.pi.amgen.com/~/media/amgen/repositorysites/pi-amgen-com/prolia/prolia_pi.pdf
About Dr. Jonathan Adachi
Dr. Jonathan (Rick) Adachi shares his time between his rheumatology practice at St. Joseph's Healthcare in Hamilton, serving as Actavis Chair for Better B one Health in Rheumatology and teaching for the Department of Medicine at McMaster University.
Dr. Adachi is currently involved in the CIHR funded Canadian Multicentre Osteoporosis Study. Dr. Adachi's studies peripheral quantitative computer tomography (pQCT) and peripheral magnetic resonance imaging (pMRI) for structural analysis of bone and cartilage.
Osteoporosis Guidelines
For more information on topics related to osteoporosis (including how long can you take Prolia), check out my Osteoporosis Guidelines.
Source: https://melioguide.com/osteoporosis-treatment/how-long-can-you-take-prolia/
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