Key takeaways:
Prolia (denosumab) is an osteoporosis injection. It’s a first-choice medication for treating this bone condition in those with a very high risk of fractures.
Prolia injections are injected every 6 months under the skin of your arm, thigh, or stomach. They should only be given by a healthcare professional. You can’t inject Prolia on your own at home.
The Prolia shot for osteoporosis can cause side effects like muscle and bone pain and raise the risk of infections. But more serious side effects are also possible, such as osteonecrosis of the jaw (breakdown of the jaw).
There are many ways to save on Prolia. If you’re eligible, a manufacturer savings card can help you get Prolia for as little as $25 per month. A patient assistance program is also available.
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Osteoporosis is a health condition characterized by weakened bones. In fact, it’s the most common bone disease in the U.S.
If you have osteoporosis, you’re at higher risk of breaking a bone. Luckily, there are many ways to keep your bones strong. Medications are one way to prevent or treat osteoporosis. There are several options, including oral tablets and injectable medications.
Prolia (denosumab) is an injectable osteoporosis medication. It’s a first-choice option for postmenopausal women who are considered at very high risk for fractures. This includes postmenopausal women who’ve had multiple fractures in the past or who have severe bone loss. If you’re prescribed this osteoporosis injection, you likely have questions about how it works and what to expect during treatment. Here, we’ll provide pharmacist-backed answers to nine common questions about Prolia.
1. What is Prolia used for?
Prolia has several FDA-approved uses:
It treats osteoporosis in men and postmenopausal women who are at high risk of fracture.
It treats osteoporosis caused by steroid medications in both men and women.
It helps strengthen bones in women who take aromatase inhibitors for breast cancer and men who take androgen blocking medication for prostate cancer.
2. Is Prolia a bisphosphonate?
No, Prolia isn’t a bisphosphonate. Bisphosphonates include medications such as Fosamax (alendronate) and ibandronate (formerly known as Boniva). They come in oral and injectable forms and are often first-choice medications for osteoporosis. But they’re also known for their stomach-related side effects, such as nausea and heartburn.
Prolia, on the other hand, is a monoclonal antibody. It’s only available as an injection that you’ll receive just once every 6 months. Oral bisphosphonates typically require daily, weekly, or monthly dosing. And even injectable ibandronate requires a dose every 3 months, which is more frequent than Polia. But Prolia is typically reserved for those at very high risk for fractures. If this isn’t the case, bisphosphonates are typically preferred.
3. How does Prolia work?
As mentioned above, Prolia is an osteoporosis injection that’s a type of monoclonal antibody. More specifically, it’s a RANKL inhibitor. RANKL is a protein in your body that helps break down bone cells. It does this by activating cells called osteoclasts.
Osteoporosis occurs when osteoclasts are too active. This means they break down bone before new bone can be formed to replace it. Prolia makes osteoclasts less active. This helps prevent bone loss and strengthens your bones.
4. How is Prolia administered?
Prolia is given as a 60 mg injection under the skin (subcutaneously). But you can’t inject it yourself at home. Instead, a trained healthcare professional will inject Prolia into your upper thigh, upper arm, or stomach once every 6 months.
Prolia can cause low calcium levels. So the manufacturer also recommends taking at least 400 units of vitamin D and 1,000 mg of calcium daily while you’re receiving it. Keep in mind that the recommended amount of vitamin D and calcium may be different for you. Your prescriber will likely check your calcium and vitamin D levels and provide dosage guidance that’s specific to your needs.
5. Does Prolia cause side effects?
Prolia is generally considered safe. But like all medications, it has possible side effects to consider.
How does Prolia compare to bisphosphonates? Prolia (denosumab) isn’t a bisphosphonate. Learn how it’s different from other osteoporosis medications.
Can you manage osteoporosis without medications? In most cases, medications are the best choice for treating osteoporosis. But if you want to explore other options, read about some other ways to strengthen your bones.
Are there medications that weaken your bones? Some medications can decrease bone density. Find out which medications may not be the best choice for you, especially if you’re diagnosed with osteoporosis.
Common side effects of this osteoporosis injection include bone pain, muscle pain, and high cholesterol levels. It may also raise the risk of skin, bladder, and respiratory infections.
Although it’s rare, Prolia can also cause more serious side effects. These include serious infections and very low calcium levels (hypocalcemia). It can also cause thigh bone fractures and osteonecrosis of the jaw (breakdown of the jaw).
Who should not take Prolia?
You shouldn't receive Prolia if you're pregnant or trying to become pregnant. It’s recommended to use birth control during treatment and for 5 months after your last dose if you haven’t gone through menopause before starting Prolia.
You may also need additional monitoring while receiving Prolia if you’re living with chronic kidney disease, have a history of thyroid or parathyroid problems, or receive dialysis. These conditions put you at a higher risk of hypocalcemia during treatment.
6. Does Prolia have drug interactions?
You may have a higher risk of low calcium levels if you combine Prolia treatment with other medications that can cause low calcium. Examples include loop diuretics and proton pump inhibitors, among others.
Prolia can also increase your risk of infection. If you take other medications that lower your immune system activity, you may increase your infection risk. This includes corticosteroids and some biologic medications.
Additionally, some experts recommend waiting 4 to 7 days between receiving a Prolia injection and a COVID-19 vaccine. This is to lower the chance of severe injection site reactions. Talk to your prescriber about whether you should wait between Prolia injections and other vaccines.
Your healthcare team can help you prevent interactions between Prolia and other medications. Providing them with an updated list of your medications can help them screen for any interactions.
7. Are there other injections that treat osteoporosis?
Yes, Prolia isn’t the only osteoporosis injection available. Other examples include:
Some of these are injected under the skin like Prolia. But others require an infusion into the vein (IV). Usually, these injectable medications are only prescribed when oral osteoporosis medications don’t work or aren’t an option. But they may be considered first-choice options for certain people with osteoporosis who are at very high risk for fractures. Talk to your prescriber about which osteoporosis treatment is right for you.
How to save on Prolia
Prolia is only available as a brand-name medication. But there are ways to save:
Save with a patient assistance program. If you’re uninsured or underinsured, you may be eligible for Prolia’s patient assistance program. This program offers Prolia free of cost if you meet certain income requirements.
Save with a copay savings card. If you have commercial insurance and meet eligibility requirements, Prolia may be as little as $25 per dose with a savings card from the manufacturer.
Frequently asked questions
In most cases, you can’t fully reverse osteoporosis. But a combination of medication and lifestyle changes can help reduce the risk of fractures and slow down bone loss. Adding weight-bearing exercise, getting enough calcium and vitamin D, and avoiding smoking and heavy alcohol use can all improve bone health. Your healthcare team can also help you find the right osteoporosis medication for your needs.
In most cases, osteoporosis is diagnosed with a bone mineral density test. The test is done using a dual-X-ray absorptiometry (DEXA) scan. This test is recommended for all women over age 65. But if you have risk factors for osteoporosis, you may need it earlier than that in some cases. The DEXA scan provides a T-score result. A negative score means your bones are thinner than average, and a score of -2.5 or lower indicates osteoporosis.
Your primary care provider or gynecologist will typically order a DEXA scan to check your bone density. They may then refer you to a rheumatologist or an endocrinologist if you require more advanced treatment for osteoporosis. Whether you need the care of a specialist typically depends on your age and what’s causing your bone density issues.
In most cases, you can’t fully reverse osteoporosis. But a combination of medication and lifestyle changes can help reduce the risk of fractures and slow down bone loss. Adding weight-bearing exercise, getting enough calcium and vitamin D, and avoiding smoking and heavy alcohol use can all improve bone health. Your healthcare team can also help you find the right osteoporosis medication for your needs.
In most cases, osteoporosis is diagnosed with a bone mineral density test. The test is done using a dual-X-ray absorptiometry (DEXA) scan. This test is recommended for all women over age 65. But if you have risk factors for osteoporosis, you may need it earlier than that in some cases. The DEXA scan provides a T-score result. A negative score means your bones are thinner than average, and a score of -2.5 or lower indicates osteoporosis.
Your primary care provider or gynecologist will typically order a DEXA scan to check your bone density. They may then refer you to a rheumatologist or an endocrinologist if you require more advanced treatment for osteoporosis. Whether you need the care of a specialist typically depends on your age and what’s causing your bone density issues.
The bottom line
Prolia (denosumab) is an osteoporosis injection that’s typically used for those at a high risk of bone fractures. Prolis isn’t a bisphosphonate medication. It’s a monoclonal antibody that helps reduce bone breakdown to keep bones strong.
Prolia is injected under the skin every 6 months by a healthcare professional. You shouldn’t inject Prolia on your own at home. Common Prolia side effects include low calcium levels, bone and muscle pain, and an increased risk of infections. In rare cases, thigh bone fractures and osteonecrosis (breakdown) of the jaw can occur. Other medications and certain health conditions can raise the risk of these side effects. Be sure to review your medication list with your healthcare team before starting Prolia.
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References
American Society for Bone and Mineral Research. (n.d.). Joint guidance on COVID-19 vaccination and osteoporosis management from the ASBMR, AACE, Endocrine Society, ECTS, IOF, and NOF.
Amgen. (2025). Prolia- denosumab injection [package insert].
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Boyce, B. F., et al. (2009). Osteoclasts have multiple roles in bone in addition to bone resorption. Critical Reviews in Eukaryotic Gene Expression.
Camacho, P. M., et al. (2020). American Association of Clinical Endocrinologists/American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis—2020 update. Endocrine Practice.
Hanley, D. A., et al. (2012). Denosumab: mechanism of action and clinical outcomes. International Journal of Clinical Practice.
National Center for Health Statistics. (2021). Osteoporosis or low bone mass in older adults: United States, 2017–2018. Centers for Disease Control and Prevention.
U.S. Food and Drug Administration. (2025). FDA adds Boxed Warning for increased risk of severe hypocalcemia in patients with advanced chronic kidney disease taking osteoporosis medicine Prolia (denosumab).
Wu, Y., et al. (2023). Reduced osteoclast-derived apoptotic bodies in bone marrow characterizes the pathological progression of osteoporosis. Cell Death Discovery.
