Evenity vs. Prolia: 7 Differences Between These Osteoporosis Injections
Key takeaways:
Evenity (romosozumab-aqqg) and Prolia (denosumab) are injectable medications used to treat osteoporosis in women after menopause. While both help to prevent fractures, they work in different ways.
Prolia is administered less often than Evenity. Prolia is administered once every 6 months; Evenity is administered once a month. And while you can use Prolia long-term, Evenity should only be used for 12 months altogether.
Evenity and Prolia are generally well tolerated. But they have rare risks to consider as well. Prolia may lower your blood calcium levels. Evenity has a potential risk of heart attack, stroke, and other heart complications.
Prolia has several approved biosimilars. At this time, Evenity is only available as a reference (brand-name) medication.
Table of contents
Osteoporosis is a condition that weakens your bones. It mainly affects older adults, especially women who have gone through menopause. Menopause leads to lower estrogen levels. Estrogen is a hormone that helps keep bones strong, so low estrogen levels can increase the risk of fractures.
To combat this, healthcare professionals often prescribe medications to prevent bone loss and increase bone strength. These medications help preserve your bone health. Some are available as oral pills, while others come as injections.
Below, we’ll cover seven key differences between two common injectable osteoporosis medications: Evenity (romosozumab-aqqg) versus Prolia (denosumab).
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1. Evenity and Prolia have different FDA-approved uses
Evenity is FDA approved to treat osteoporosis for women who have gone through menopause.
Prolia is also approved to treat osteoporosis for women after menopause. But Prolia is approved for other conditions and groups of people, too. Prolia can help treat:
Men living with osteoporosis
Osteoporosis caused by corticosteroid medications
Men experiencing bone loss after taking certain anti-androgen medications for prostate cancer
Women experiencing bone loss after taking certain anti-estrogen medications for breast cancer
2. Evenity and Prolia don’t work the same way
Evenity and Prolia are both monoclonal antibodies. Monoclonal antibodies are biologic medications that function like certain parts of your immune system. But monoclonal antibodies encompass a large group of medications, and Evenity and Prolia each work differently.
Evenity works by blocking a protein called sclerostin. This protein usually stops bones from growing and promotes bone decay. By blocking sclerostin, Evenity slows the breakdown of old bone and helps your body build new bone.
Prolia works by blocking a protein called RANKL. This protein sends signals to cells that break down bone. By blocking RANKL, Prolia helps to slow down bone loss. This helps promote stronger bones.
Treating osteoporosis: GoodRx pharmacists and physicians discuss how to choose the best osteoporosis medication for you.
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Monitoring your risk: Read about common medications that may negatively affect your bone health.
3. Prolia is administered less frequently than Evenity
Evenity and Prolia are injected subcutaneously (under the skin) into the upper arm, abdomen, or thigh. Both medications are given by a healthcare professional.
Evenity is given once a month as two back-to-back injections. Together, the two injections add up to 210 mg. Evenity should only be used for 12 months, which we will discuss more below.
Prolia is given once every 6 months as a single 60 mg injection. Your healthcare professional might recommend using Prolia long-term.
4. Evenity has a fixed treatment duration
Experts recommend using Evenity for a fixed period of time of 12 months. This is because Evenity’s bone-building effects decrease after 12 months of treatment. If you need osteoporosis treatment for longer than 12 months, your healthcare team will help you find an alternative medication after this timeframe has passed.
Prolia doesn’t have a fixed treatment duration. How long you use Prolia depends on your needs and what your healthcare professional recommends.
That being said, stopping Prolia before starting a new osteoporosis medication can lead to rapid bone loss. This can raise your risk of fractures, especially in the spine. It’s important to have a plan before stopping Prolia. So be sure to talk to your healthcare team before stopping your treatment.
5. Biosimilars are approved for Prolia, but not Evenity
Brand-name medications can come with a lofty price tag. Often, generic versions are available at a lower cost. Biologic medications don’t have generic versions, though. Instead, they have biosimilars.
Biosimilars are biologic medications in their own right. They’re just similar to a reference (original) biologic medication that the FDA has already approved. Biosimilars work as well and are as safe as their reference medication. So you can expect the same results from the biosimilar medication.
Currently, there are five approved Prolia biosimilars:
Jubbonti (denosumab-bbdz)
Ospomyv (denosumab-dssb)
Stoboclo (denosumab-bmwo)
Osenvelt (denosumab-bmwo)
Conexxence (denosumab-bnht)
Osenvelt and Stoboclo may become available for use in June 2025. The release dates for the other Prolia biosimilars are still to be determined.
Evenity is only available as a reference (brand-name) medication. It’s not currently available as a biosimilar.
6. Evenity and Prolia have different side effect profiles
Prolia is generally well tolerated. But it can cause side effects. Common Prolia side effects include back pain, pain in your arms and legs, and muscle or joint discomfort. Other possible side effects are high cholesterol levels, swelling in the hands and feet, and dizziness. These side effects may get better over time as your body gets used to the medication.
The most common Evenity side effects are joint pain and headaches. Other side effects include swelling in your arms or legs, feeling weak, or having trouble sleeping.
Both medications can also cause serious side effects, but they happen less often. Sometimes, the risks are serious enough that the FDA adds a special warning to their product labeling.
7. Each medication has its own boxed warnings
Some medication side effects can be serious or life-threatening. When this happens, the FDA may instruct a pharmaceutical company to add a boxed warning to its medication’s labeling. This warning highlights the serious risks of using the medication. Many medications have this kind of warning. But that doesn’t mean they’re unsafe when they’re used and monitored appropriately.
Evenity may raise the risk of heart attack, stroke, or death from heart issues. So Evenity isn’t usually recommended if you’ve had a heart attack or stroke in the past year. Also, Evenity may not be the best option if you have other risk factors for heart attack or stroke, such as high blood pressure, high cholesterol, or diabetes. Your healthcare professional will decide if the benefits of Evenity outweigh the risks for you.
Prolia may lower your blood calcium levels. This is especially true if you have kidney issues or are receiving dialysis. Low blood calcium levels can lead to serious issues. In rare cases, it may cause irregular heart rhythms (arrhythmias) or seizures.
It’s important to get enough calcium and vitamin D while receiving Prolia. Prolia’s manufacturer recommends taking at least 1,000 mg of calcium and 400 IU of vitamin D each day. But your healthcare professional may recommend a higher amount based on your needs. They will also regularly test your blood to monitor your calcium levels.
How to save on Evenity and Prolia
Evenity and Prolia are both available as reference products. But you may be able to find Prolia as a lower-cost biosimilar (as of late May to June 2025). GoodRx can help you navigate ways to save on your prescription.
Save with a copay savings card. If you have commercial insurance and meet eligibility requirements, Evenity or Prolia’s price is as low as $25 per dose if you use the manufacturer’s savings card.
Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for Evenity or Prolia’s patient assistance program, which offer the medication at no charge. Both medications are made by the same company, Amgen.
The bottom line
Evenity (romosozumab-aqqg) and Prolia (denosumab) are injectable medications that treat osteoporosis. Prolia is given every 6 months, and there’s no set duration for use. Evenity is administered once monthly for a maximum of 12 months. Prolia has several biosimilars, but Evenity is only available as a reference (brand-name) product. Both medications have risks and may cause side effects. Most commonly, Prolia can cause back pain while Evenity can cause joint pain. A healthcare professional can help you choose the best option for you.
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References
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Krupa, K. N., et al. (2024). Romosozumab. StatPearls.
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U.S. Food and Drug Administration. (2019). FDA approves new treatment for osteoporosis in postmenopausal women at high risk of fracture.
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