Prolia vs. Forteo: Which Medication Is Better for Osteoporosis?
Key takeaways:
Oral medications are often the first choice to prevent broken bones in people with osteoporosis. They are affordable, but they can have unpleasant side effects.
Two newer alternatives are injectable treatments, like Forteo and Prolia. They have risks of their own, but most people tolerate them better than the oral medications available. Both may be a better option for people who have a very high fracture risk.
There are many ways to save on Forteo and Prolia. If you’re eligible, manufacturer savings cards can help make your prescription more affordable. Patient assistance programs are also available.
Osteoporosis is a common health problem for adults over the age of 50, affecting 10.2 million men and women every year in the U.S. This condition happens when your body breaks down too much bone, doesn’t make new bone fast enough, or a combination of both. This can cause your bones to weaken or even break, which can be dangerous. If you’re over 50 years old, breaking or fracturing a bone raises your risk of death.
To help prevent broken bones, healthcare providers will usually prescribe people with osteoporosis a medication that stops your body from losing more bone. The first choice for many people is an oral bisphosphonate medication, such as Fosamax (alendronate) or Actonel (risedronate). However, providers may choose a different medication if you cannot tolerate these due to:
Excessive side effects like acid reflux or stomach pain
The medications not working well enough
You having a very high risk of breaking a bone
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Two of these alternatives are Forteo (teriparatide) and Prolia (denosumab). They can be used for both men and women, as well as people whose osteoporosis was caused by long-term use of certain medications like corticosteroids (prednisone, for example). Forteo and Prolia cause side effects less often than bisphosphonates, especially when it comes to stomach-related issues like nausea and indigestion. The biggest downsides for Forteo and Prolia is that they’re injectable medications and can cost thousands of dollars more than the older treatments.
More research needs to be done comparing them to bisphosphonates. However, current research shows that Forteo is better than bisphosphonates at preventing spinal fractures. Also, one study found that Prolia protects you from osteoporosis-related fractures better than Fosamax after you’ve been using it for 2 years, though the data is still limited when comparing Prolia to other bisphosphonates. This emerging evidence is why providers are choosing these two medications over bisphosphonates when your bone mineral density is very low and you have a high risk of breaking a bone.
Below, we’ll discuss how these two newer osteoporosis treatments are similar and how they differ from each other, as well as common side effects, their costs, and possible risks of taking them.
Is Forteo the same as Prolia?
While Forteo and Prolia are both injectable options for treating osteoporosis, they work in different ways. Forteo works like a hormone and needs to be injected once a day. Meanwhile, Prolia works with your immune system and is injected twice a year.
Forteo
What it is
Forteo is a parathyroid hormone analog. This means it acts like the parathyroid hormone (PTH) found naturally in your body. PTH is responsible for helping your body turn calcium into new bone. When you take Forteo, it tells your body to create more bone.
How to take it
Forteo comes as an injection that you give yourself once a day in either your thigh or abdomen. Each Forteo pen contains 28 days of medication. You attach a new pen needle to the tip of the pen before giving yourself an injection. Because this medication does have some serious side effects (see below), you should only use Forteo for a total of 2 years over your entire life.
Prolia
What it is
Prolia is a monoclonal antibody, a type of protein that acts like part of your immune system. Prolia works by stopping your body from breaking down bone. Meanwhile, your body will continue to naturally create new bone, leading to more bone overall.
How to take it
Prolia comes as an injection that has to be given by a healthcare professional once every 6 months, meaning you will have to go to your provider’s office to get it. Many insurance companies and pharmacies will require the medication to be mailed directly to your provider’s office so that it stays at the right temperature until you receive your dose.
While you are using Prolia, you must have regular blood tests done to check your calcium levels, as very low calcium is one of its more serious side effects. (See below for more info on Prolia’s side effects.)
Which medication is more effective?
Most of the research done with Forteo or Prolia compares them to oral osteoporosis medications. It’s been shown that Forteo and Prolia are better at raising your bone density than the available oral treatments. That’s why the American Association of Clinical Endocrinologists (the osteoporosis experts) recommends starting with one of these medications if you have severe osteoporosis or a very high risk for breaking a bone.
Unfortunately, there aren’t many studies comparing Forteo directly with Prolia. One of the only studies available comparing Forteo with Prolia did show some slight differences between the two. Forteo was better at preventing spinal bone loss, while Prolia was better at preventing bone loss at the hip. These differences could lead to your provider choosing one over the other.
Forteo: Side effects and possible risks
Side effects
Muscle and joint pain
The most common side effects for Forteo are muscle and joint pain, which can happen to between 10% and 21% of those who use it.
Others
Other possible side effects aren’t quite as common and happen to only 5% to 10% of people who take Forteo. These include:
A runny nose
Nausea
High blood pressure
Coughing
Muscle weakness
Indigestion
Constipation
Diarrhea
A sore throat
Dizziness
Possible risks
Like all medications, Forteo does have some risks to be aware of while taking it.
Bone cancer
The most serious risk is possible bone cancer. Your risk of this goes up the longer you use the medication, which is why you should only take it for a total of 2 years during your entire lifetime. Your risk of bone cancer can also be raised by certain medical conditions or medications, such as:
A personal or family history of bone cancer
History of certain forms of radiation
Growth plates that haven’t closed yet
These people are recommended to avoid taking Forteo.
High blood calcium levels
Another risk of Forteo includes high blood calcium levels, which can lead to kidney stones. People with a condition called hyperparathyroidism shouldn’t take Forteo. This is because you are more likely to already have high blood calcium levels before starting Forteo. It’s important to follow your provider’s scheduling for any blood tests they order. Also, let your provider know if you start to develop kidney stones more often than usual after starting this medication.
Drop in blood pressure
A drop in blood pressure when changing positions — called orthostatic hypotension — can happen to a small number of people right after giving yourself an injection. This is temporary and passes within a few hours. After the injection, change positions slowly and hold on to a sturdy surface while standing. Or you can give yourself the injection right before bed to help prevent falling.
Interactions with other medications
Lastly, Forteo interacts with the heart medication digoxin (Lanoxin). When you take these two medications together, Forteo can cause digoxin to build up to dangerous levels in your body. So Forteo might not be the best option for treating your osteoporosis if you are taking digoxin. Make sure your provider knows if you take digoxin before you start Forteo. You might have to go for more frequent blood tests to check your digoxin levels while on this medication.
Prolia: Side effects and risks
Side effects
Back, muscle, and joint pain
The most common side effect of Prolia is back pain, which affects up to 35% of those who take it. Other types of muscle or joint pain are also common, with 3% to 12% of people experiencing this.
Others
This medication can also cause the following side effects for 5% to 10% of people:
High cholesterol
Bladder infections
Dizziness
Upper respiratory infections
You should not use Prolia if you are pregnant, as it can cause birth defects and miscarriages.
Possible risks
There are some serious possible risks for those taking Prolia.
Low blood calcium levels
Prolia is known to cause low blood calcium levels, so it’s important for you to take a daily calcium and vitamin D supplement while you’re taking it. Your provider will have you get blood tests to check your calcium levels before your first dose and then regularly get tested while you’re taking Prolia. If you have severe kidney problems, you are more likely to have this problem.
Breaking down of jaw bones
Another serious side effect that Prolia causes is osteonecrosis of the jaw (ONJ). This is when the bones in your jaw start to break down and die. ONJ is very rare and usually only happens when you have teeth pulled or need other major dental work. It can also happen if you wear dentures that don’t fit correctly. Routine dental check-ups are very important while you’re taking Prolia to help keep your risk for ONJ as low as possible. Be sure to let your dentist know before you start taking this medication.
Infections
About 4% of people experience serious infections more often than usual while taking Prolia. Some types of infections listed by the manufacturer include conditions like skin infections, pneumonia, and shingles. As a result, you should let your provider know if any of these infections are severe or require you to be treated in a hospital. A very small number (0.2%) of people taking Prolia end up with life-threatening infections. If this happens to you, this medication might not be the best option for you to keep taking.
Delayed doses
One last risk to be aware of with Prolia is what can happen if you are late for a dose. Once the effects of Prolia start to wear off, you will have a very high risk of breaking bones (higher than before you started using the medication). Even being a few weeks late can cause this issue, so be sure to stay on track with your appointments to receive your dose.
Can you take Forteo and Prolia together?
A recently published study has shown taking Forteo and Prolia together raises your bone density. This study was small and did not look at whether this higher bone density actually helped prevent fractures. The combination is likely safe to take, but it can become costly depending on your insurance coverage.
Until there is more evidence that taking both medications prevents broken bones better than either one does alone, the combo most likely won’t be recommended by experts. If your provider does want you to take both Forteo and Prolia, it’s probably because you have severe osteoporosis or have not seen improvement from one of these medications by itself.
How to save on Forteo and Prolia
There are ways to save on Forteo and Prolia, which are only available as brand-name medications. GoodRx can help you navigate between patient assistance programs and copay savings cards to save money on your prescription.
Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for Forteo's or Prolia's patient assistance programs, which offer the medications free of cost.
Save with a copay savings card. If you have commercial insurance, you may be eligible to pay as little as $4 for Forteo or $25 for Prolia using a savings card from the manufacturers.
The bottom line
Both Forteo and Prolia are injectable osteoporosis treatments that may be a better option than oral medications for individuals who have a very high fracture risk. They are two of the first choices if you have a high risk of breaking a bone. Though they do have some possible risks, most people tolerate them better than the oral medications available.
They each have their strong points, so which one you take is usually based on your personal preference:
Forteo is better if you have low calcium levels. It can be given at home but can only be used for a maximum of 2 years.
Prolia can be used long-term and only requires two shots a year, which must be given by a healthcare provider. But Prolia can impact the bones in your jaw, so you’ll need to get regular dental check-ups when taking it.
Regardless of which you choose, know you are getting one of the most effective osteoporosis medications currently available.
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