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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.] 

Prolia Questions

The most common questions that I hear from patients and readers of this blog are:

  1. How does Prolia work?
  2. How long can you take Prolia?
  3. How to discontinue Prolia?
  4. What are the side effects (and potential dangers) of taking Prolia?
  5. How long do Prolia side effects last?
  6. Can Prolia side effects be reversed?
  7. 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.

how long can you take Prolia

Key Takeaways on Prolia

Here is an executive summary of the key points made in this Prolia article.

  1. 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.
  2. 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.
  3. 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.
  4. If you are at a high risk of osteoporosis fracture and your physician advises Prolia injections, you should consider following her or his advice.
  5. 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.
  6. 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:

  1. 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?
  2. If you experience serious side effects, what is the plan to discontinue Prolia shots and transition to another pharmaceutical treatment?
  3. 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?
  4. Ask your physician to refer you to a Nutritionist who can review your diet to determine you are getting adequate bone building nutrients?
  5. 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

Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.

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.

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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:

  1. Postmenopausal women with osteoporosis who are at high risk for osteoporotic fractures should use denosumab (Prolia) as an alternative initial treatment.
  2. 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:

  1. Women diagnosed with postmenopausal osteoporosis (and a high risk for fracture) or receiving adjuvant aromatase inhibitor therapy for breast cancer.
  2. Men at high risk for fracture due to osteoporosis or receiving androgen deprivation therapy for nonmetastatic prostate cancer.
  3. 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

Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.

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.

  • This field is for validation purposes and should be left unchanged.

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.

  1. 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.
  2. 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.
  3. 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:

  1. Can you stop taking Prolia?
  2. 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:

  1. The period after they have had only one Prolia shot.
  2. 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:

  1. Acute symptoms like rash and low blood calcium occur early within the first couple of weeks.
  2. Long-term side effects like osteonecrosis of the jaw (ONJ) may occur at any time, but are extremely rare.
  3. 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

Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.

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.

  • This field is for validation purposes and should be left unchanged.

 

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:

  1. Osteonecrosis of the jaw (ONJ).
  2. Atypical fractures.
  3. 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:

  1. Patients with multiple fractures with very low bone density use Forteo.
  2. If you have undergone radiation therapy or who have Paget’s disease, you should not use Forteo.
  3. 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.
  4. 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

Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.

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.

  • This field is for validation purposes and should be left unchanged.

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:

  1. 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?
  2. If you experience serious side effects, what is the plan to discontinue Prolia shots and transition to another pharmaceutical treatment?
  3. 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?
  4. Can your physician refer you to a Nutritionist who can review your diet to determine you are getting adequate bone building nutrients?
  5. 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:
 
  1. 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
  2. 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.
  3. 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.
  4. 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.
  5. 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
  6. 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
  7. 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
  8. 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.
  9. Lamy, O. Et al. Stopping Denosumab. Current Osteoporosis Reports. 2019 Feb;17(1):8-15. doi: 10.1007/s11914-019-00502-4
  10. 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.
  11. 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
  12. 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.
  13. 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
  14. 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.
  15. 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
  16. Zoledronate After Denosumab Does Not Fully Prevent Bone Loss. MedScape. June 18, 2020.
  17. 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
  18. 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 Bone 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.

Comments

January 24, 2017 at 12:24pm

Sandy

Were the fractures a result of coming off the drug or possibly because of taking the drug in the first place. I saw this Dr and took an injection of prolia because of his recommendation/ scare tactics and was never so sick in my life. Upon returning to see him because of this he refused to even consider that my reaction was due to the drug when I had felt perfectly fine before taking it. He was both rude and arrogant talk about cooking the books on that research

January 28, 2017 at 3:27pm

Margaret Martin replies

Hi Sandy, I am not in a position to give you a definitive answer. However based on the case studies that were presented several of the women were only in their 50's, had no previous vertebral fractures and within 15 months of receiving their last of several injections had vertebral fractures. This does make one wonder as the authors brought up:
1. what is the pathophysiology of this drug? i.e. what is it doing to the bone that it improves the density of the bone but certainly appears to have a negative effect on the quality of the bone.
2. Who are the individuals best suited for the drug? Are there aspects of their medical history/genetics/etc that might make someone more susceptible to this "rebound effect"than another?

I have had many clients report flu like symptoms after their first injection.

Sorry that you had such a negative interaction with the doctor who gave you Prolia. Most health care practitioners (yes, MD's included) only want the best for their patients. They have a lot of information to process and are making decisions/recommendations based on the information they have at the time.

Have a happy day. Margaret

January 24, 2017 at 12:47pm

LILIA WARD

Thank you for this very valuable information on Prolia. I just started six months ago and am about to have my second injection. It is also very informative to know that 10 years is about the time table for the use of Prolia . I am 77 years old so hopefully my bones will heal or have some improvements before my "time is up".... Thank you again.

January 24, 2017 at 12:47pm

Janet Thomas

Hello Margaret,
I have had 2 injections of Prolia and am allergic to it because of the dreadful itching that I sustained after 5 months of being on it. I did not have the 3rd injection because of this and am due to discuss this with my Endocrinologist in February.
I sustained 5 compressed fractures BEFORE I was put on Prolia over a year ago, so what am I to do now please? I certainly do not wish to get more fractures if I come off the drug.
Janet Thomas.

January 28, 2017 at 3:12pm

Margaret Martin replies

Hi Janet, I encourage you to discuss your options with your endocrinologist and continue doing your exercises.
Take care, Margaret

January 24, 2017 at 5:03pm

Penn

Margaret said here, "At this point, in case you didn’t read all the details of my first blog on pharmacotherapy, Dr. Adachi implied, “If you’re on Prolia, you’re on it for at least 10 years, so plan to be on it for 10 years."

He did not imply any such thing, Margaret. He said:
"There is evidence that denosumab may be continued for up to ten years with ongoing improvement in spine bone mineral density (BMD). It may be that denosumab may be continued longer however we do not have clinical studies that go beyond ten years.

"Stopping denosumab will lead to rapid reversal on bone mineral density (BMD) and may predispose a person to fractures again. If denosumab is to be discontinued then alternate therapy should be considered to prevent the loss of the gains in BMD with denosumab."

He certainly did not cite the study showing women experiencing an average rate of 5.5 vertebrae fractures after discontinuing Prolia after a few doses. I've just come from a consultation where the clinical nurse advised just the course that yielded the problems--treatment with Prolia for two years, then discontinuation. She also did not mention this study. I was sold on Prolia until I read this and read other studies that show it's not the great solution I'd thought it might be. Until solid research is done on women who started taking a bisphosphonate after discontinuing Prolia, I have no confidence that that strategy is protective against vertebral fracture either.

On a positive note, I AM inspired by your solid material on exercise and good diet as means to preserve and build bone density. I will be getting your book and incorporating it into my new fitness program.

But in the future, please don't hold back on detailed information, including study citations. We need it. The medical community certainly is not providing it to us.

January 28, 2017 at 3:10pm

Margaret Martin replies

Hi Penn, Thank you for your correction. It may have been more what I heard him say to my client during the teleconference than what he wrote in his Q & A. But since reading the papers from the Swiss endocrinologists I am concerned for all my readers who are currently on Prolia. .
Once someone has numerous vertebral fractures they have little options other than to be extremely vigilant not to give into gravity. Here is an example of one some of the strategies one can do: http://melioguide.com/osteoporosis-treatment/treat-compression-fracture/

Thank you for your support by purchasing one of my books. I will do my best to provide detailed information in my future blogs.

Keep well, Margaret

January 24, 2017 at 8:12pm

Jeannine Leroux-Lafontaine

Hi Margaret!
Thanks for this informative video!

January 25, 2017 at 9:02am

Gabriele Drazien

Dear Margaret,
I am a patient who had 4 vertebrae fractures and then was put on denosumab, prolia and had very unpleasant side affects was not willing to take it any more! Then was put on Forteo for one year. Only after I stopped and refused to take anything else any more I realized also numerous conditions I had while taking it - disappeared. Since then I am on a vigorous exercise with weight training to strengthen my back and belly area and a 10 a day dried prune diet for the last two years. My bone density stayed the same or got a little better in certain areas. I try to eat well and have enough protein. I don't know what did it. May be a combination of everything or still after affect of the forteo I took?! I guess I'll find out In one year or two if it is still the same, or might have a bone problem before!? I am willingly playing roulette and hoping it will help me without drugs!

January 28, 2017 at 3:34pm

Margaret Martin replies

Hi Gabriele, Thank you for sharing your story. Glad you are taking such good care of your bones. FYI, the author of the prune study has found equally as positive results with 5 prunes a day! Keep up the strength training and remember to balance your protein with lots of vegies to keep your diet alkaline.
I do not see you as someone who is playing roulette but rather someone who has decided to take control of their life. Well done.
Margaret

August 25, 2017 at 12:57pm

Margaret Belo

Hi Margaret my name is Margaret also I have been on prolia, I'm on my 5 injection. I have been pleased with prolia no side effects, i'm very active and do a lot of walking and exercise. My main concern is the price i started off paying $180.00 and now this last injection is costing me $322.00 an injection. This is way to expensive for me so I'm considering on discontinuing taking this medication. It's ridiculous to pay that price if you can't afford it, why does the health care put you on a medication that you need and then prices keep going up. i'm very upset about having to pay that amount. Thank you! Margaret

September 21, 2017 at 8:07am

John Dunsmore

I want to stop prolia because of side effects is there a problem with that I hope not

September 21, 2017 at 7:53pm

Margaret Martin replies

Hi John,
As my article indicates there may be a problem with stopping Prolia once it is started. It appears that no one yet knows the minimum or maximum time someone should be on it. Since the drug has only been used on people for the past 10 years it appears that as long as you're on it, it is safe for your bones. As Dr. Adachi implied, "If you're on Prolia, you're on it for at least 10 years, so plan to be on it for 10 years. The exit strategy that you are going to take when coming off Prolia is one that you want to carefully discuss with your specialist so that you are careful to make sure that your bones are safe when you're coming off of Prolia."
The trouble is the exit strategy. He as well as the endocronologists in Switzerland noted that coming off early can affect the quality of bone in your spine and lead to vertebral fractures. As with all drugs, you have to discuss the pros and cons with your physician.

September 26, 2017 at 5:38pm

Lin Shaw

I had my first (and last!) Prolia injection 8 days ago. Within two days of administration of the shot, my lower back went into severe spasm. Unbearable pain...the prescribing doctor said to take Advil! I've been to a pain relief center, which has helped some, but I wonder how long this terrible side effect will last.

Regarding the increased risk of fracture if stopping Prolia (meaning not taking any more shots), isn't my risk lowered because I've only had one shot, rather than multiple shots? The shot is supposed to last six months, so wouldn't I be protected for at least that long? What if I went to an oral bisphosphonate like Fosomax or Actonel in six months? Would that protect just as well?

September 26, 2017 at 8:48pm

Richard Martin replies

Hi Lin:

You should consult with your physician on your Prolia plans and other pharmaceuticals. Much is dependent on your medical history and profile and we are not in a position to provide an informed comment.

September 27, 2017 at 8:17pm

Margaret Martin replies

Hi Lin,
Sorry about your pain. Your questions are all very good but unfortunately I do not have answers to your questions. Possibly your physician who administered the Prolia may. Margaret

September 30, 2017 at 7:55am

Carol

I had my 2nd prolia injection in June. After my 1st one in December, I started having night sweats and experiencing severe dry eyes. I did not relate it to Prolia (thinking it was post-menopausal issues) until after my 2nd injection. Night sweats wake me up several times a night, my eyes feel like sand, and I developed a cough. My doctor ordered some blood tests and my sugar levels are so high that I am being tested for diabetes! My blood pressure is also much higher than normal. I have never had high blood pressure and never had issues with my sugar levels. I am convinced (after reading of so many people having issues too) that all of this is because of Prolia because it all started after my 1st injection. While my doctor was initially skeptical, she is now listening and is supporting my thinking to not have 3rd injection.

October 3, 2017 at 10:25am

Margaret Martin replies

Hi Carol,
I am glad you have a physician who is listening to you and helping you get your health back. I encourage you to also submit your list of side effects to the FCA as Lin Shaw suggested:
https://www.accessdata.fda.gov/scripts/medwatch/index.cfm?action=reporting.home
All the best.

September 30, 2017 at 5:52pm

Margaret

I have been on prolia for one year just had my third shot....I have Gaines quite a bit of weight ..even. Though I excecise etc,,,watch m y diet ...I asked my doctor could I come off it ..but I was told my bone density would go very. Low again...I have had a fracture of back and smaller ones through the years still very young 67 ....why can't I come off it .....? Told I had missed the boat Should have watched my bones years ago ..is this hereditary?

October 1, 2017 at 2:34am

Lin Shaw

Hi Margaret & Richard,
Thank you for your responses. Allow me to ask a more generic question. Assuming the Prolia stays in the patient's system for six months, would you expect side effects to diminish during that period, or possibly remain with the patient longer?

BTW, in my experience, most prescribing physicians don't like to acknowledge even the existence of side effects.

October 3, 2017 at 10:13am

Margaret Martin replies

Hi Lin,
Great question! I will try to find out the answer for you.
Margaret

October 2, 2017 at 8:34pm

Lin Shaw

Yesterday I notified the FDA of the severe side effects I was experiencing from Prolia. It's a very simple online form, which took just a few minutes to complete:

https://www.accessdata.fda.gov/scripts/medwatch/index.cfm?action=reporting.home

Few patients, and even fewer physicians, report side effects, so drug manufacturers get to continue claiming side effects are "rare." If we don't report, no one will.

October 8, 2017 at 12:42pm

Lin Shaw

Hi Margaret,
In your post of Oct 3, I think you meant the FDA (not FCA). That stands for the Food & Drug Administration in the US.

October 20, 2017 at 9:09am

Chantal Lapierre

Dear Margaret,
I am so glad to have found your article! I was diagnosed with breast cancer two and half years ago, and I was prescribed and AI to help prevent the cancer from comig back. To make a long story a bit shorter, one of the side effects of Letrozole is that my bone density has decreased and I now have a T-score of -2.8, which means I have osteoporosis.
My physician strongly recommended Prolia, but after a lot of research, I came to the decision to go the natural way. My physician is not happy with my decision and has ignored my request for advice. Which is a shame, and even had me questioning my decision .
Your article strengthened my resolve.
I decided to continue taking Vitamin D3, Calcium, and K2 and do daily exercise to strengthen my bones the natural way.
Have a great day!
Chantal

October 20, 2017 at 9:21am

Chantal Lapierre

Margaret,
you said "Pharmaceuticals may be appropriate for individuals in urgent need of an increase in bone density. "
What you would you describe as an urgent need? Currently mt t-score is -2.8 and as I said earlier, I do not want to go for the Prolia shot.
Thanks again!

October 23, 2017 at 9:51pm

Margaret Martin replies

Hi Chantal, I would describe an urgent need as someone who has already sustained and osteoporotic fracture(s). The big issue with Prolia is not so much the side effects but rather that we do not know how to take someone off of it. So if your in your late 70's then it is much less of an issue than someone in their 50's. I hope this helps. Take care and be sure to do your balance exercises.
Margaret

October 28, 2017 at 9:44am

Chantal Lapierre

Margaret,
Thank you so much for your answer. I am in very good health otherwise, and I take my supplements and exercise every day, in addition to a aily four mile walk on the beach.
Before finding you website, I visited many others where women who are currently given the Prolia shot gave their remarks. This was not good! I gathered data from 5 websites; 375 bad reviews, 70 good. Those are not good odds.
I sent the results of my research to my surgeon, along with the address of your website. After reviewing all this, she decided to no longer give the Prolia shot to her patients. She plans on recalling all those who already had it and come up with a straategy to take them off of it.
I am proud of her for listening to me. Currently, I am followed by 3 different healthcare professionals. She is the only one who took me seriously. Kudos to her!!!

October 29, 2017 at 9:40pm

Margaret Martin replies

Bravo Chantal! Kudos to you for doing such a thorough review and sharing it with your surgeon. Keep well.
Margaret

October 29, 2017 at 3:26pm

Valli Evans

Margaret,
I am 68 years- old and had a bone density test in June, 2017. Here are my scores:
Since prior exam of 11/05/2003, the bone mineral density in my lumbar spine as increased by 0.7%. My T-Score is -1.4. My total hip region is -1.5. I have been diagnosed with Osteopenia in these areas. However, My T-Score in the Femoral Neck area has increased by 14.1% since 11/5/2003, I am considered to have Osteoporosis in this area. My primary care doctor suggests Prolia with no side effects. After seeing all the comments on your websites, i am scared to death to take this injection. I exercise daily with walking, lifting weights, balance exercise and good nutrition. I haven't had any fractures or pain. Do you have any suggestions?

October 29, 2017 at 9:36pm

Margaret Martin replies

Hi Valli,
I hope my bones are as good as yours in 10 years! The fact that you have increased your BMD is formidable. After menopause even maintaining is considered gaining but you have done even better. Well done. You are obviously doing all the right things. I am a little perplexed as to why your doctor is suggestion Prolia. Although you mentioned and increase in your femoral neck BMD you did not mention what it was.
My suggestion is to do your FRAX:
http://melioguide.com/FRAX/
The FRAX provides you with a better picture of your bone strength and fracture risk. See what the results tell you and have a discussion with our doctor based on the facts. From the information you have provided me you appear to be in control of your bone health and you are wisely questioning your doctor's recommendation.
Keep up the good work.
Margaret

October 30, 2017 at 7:41pm

Jeanne Lo

Margaret,
I’m a 55 yrs old Asian female whose on Prolia for 2 1/2 years with no known side effects. I’m worrying about how long do I have to be on this medication after I’ve been reading on your website. Ten years is a awful long time. I think I would like to speak to an Endocrinologist for advice on how to withdraw from Prolia.

November 1, 2017 at 6:40pm

Margaret Martin replies

Hi Jeanne, It is certainly wise to speak to the endocrinologist before you make any changes. All the best,
Margaret

November 2, 2017 at 12:29am

Marielle Shields

I have received two injections of Prolia and have no side effects so far . I have been on prednisone for seven years for SLE and my bones are brittle. In the last ten months I have had one rib fracture in January,four ribs fractured in March and broke my foot last month. My doctor decided that I should be on Pralia . I am 84yrs old and I am planning to stay on it for the rest of my life.

November 8, 2017 at 6:06pm

Joanne

I was on prolia for 2 years and a year after my second injection, I had a tooth pulled and it would not heal, then I got an infection that went into my jaw bone,that caused me to be hospitalized for 4 days, having more teeth pulled along with having dead bone in my jaw bone removed. I was never told about what prolia would do to cause such terrible side effects. I still have another appointment to have bone removed from my most recent tooth extraction. I'm 85 and I really REGRET taking prolia! So beware folks. Medecine can really mess a up like me! I'm angry!

November 21, 2017 at 6:15am

Ann

I'm on proilia the last four years I was told my bones are fine I would like to come off it any suggestions

December 9, 2017 at 6:01pm

ilona

Doctors don,t know what they are talking, what Amgan tells so they say, but really it is poison. I would like to read how many doctors are taking it. When people telling to doctor about side effects they say than can,t be.

December 21, 2017 at 5:58pm

DANIELLA BARDA

Hello Margaret and thank you for posting this interesting article.
I honestly wish I had read it earlier. I am 55 yrs old and have just been diagnosed with "severe osteoporosis" (according the the specialist) with a score of -2.8 in certain vertebrae.
My doctor recommended started Prolia straight away and I have already had a first injection. I am very concerned by the studies you cite regarding the dramatic risk of fracture after stopping Prolia because as a result I will certainly need to be taking this medication for more than 20 years considering my age. From my reading of your article I understand that no studies have yet ascertained the impact of feasability of taking Prolia for so many years. I am relatively active though I mainly swim as I also have arthritis in my two big toes and some pain in hips and knees due to hypermobile joints and decreased muscle tone. I'd be very interested in looking at your books regarding exercise for osteoporosis. The rheumatologist I saw actually told me it weight bearing exercise would be of no use to me now as I haven't done any in the past (although I did dance for 30 years). Is that your take on things too?

December 29, 2017 at 5:21pm

Margaret Martin replies

Hi Daniella,
It is very important to do weight bearing exercises such as walking, stair climbing etc. Since you are only 55 years old and you plan to be able to lift your own body weight off of a chair (chair squats) and be able to function out of the water with good body mechanics (especially important when you are hypermobile). I would encourage you to supplement your swimming with weight bearing and strength training. You may need the guidance of a good coach to help you ensure proper form. Balance exercises out of the water are also important to reduce your fall risk.
All the best.
Margaret

January 7, 2018 at 5:17am

Linda kapou

Hello doctor l have just watched your video and found it very informative: I was diagnosed with osteoporosis two years ago with a high risk of bone fracture and my doctor decided that in my best interest would be to take prolia but I must say that this was the worst possible thing that I could have done,after the second injection I had the worst side affects ever in my legs and the lower back and they lasted for three months and then I got an infection in my gums and lost two teeth l really am in a dilemma what to do about having the next injection having read your article that once prolia is started it must be continued for ten years please tell me what to do thank you

January 11, 2018 at 8:36pm

Margaret Martin replies

Hi Linda,
Sorry to read about your story. I would also be concerned about taking another injection. I am not a doctor. I am a Physiotherapist. I cannot tell you what to do, but I suggest that if you have not spoken to your doctor about the problem that arose, that should certainly your first step. You may want to ask to be referred to another doctor or specialist (endocrinologist) who can provide you with other options or at least a second opinion. Get as many facts as you can and then make the decision that is right for you.

January 14, 2018 at 10:50pm

Nathalie

Hello doctor,
I’m getting worried about my Prolia treatments that I’ve been receiving for the last 3 years... My doctor started my treatment when I was 48 yrs old, after having a fracture of my foot. My bone density results showed I had an advanced case of osteoporosis. However, I am not menopausal yet... he wanted to try and see if this treatment would work for me even though I wasn’t post menopausal. So after 6 injections, the last one was last November, now we’ll wait another year and he’ll send me for another bone density test. I’ll be 52yrs next October. I have fibromyalgia so I’m in constant pain but I can’t be sure if it’s the Prolia that’s causing most of my hip and joints pain, plus my spine hurts pretty bad ! I’ve been having sciatica problems also. I’ve some other symptoms of side effects that may be caused from taking Prolia that I should’ve checked sooner. Now I’m worried that by getting off the Prolia treatment I’ll be at high risk for multiple vertebrae fractures... it’s scary to think about it! What are your thoughts?
Thank you

January 17, 2018 at 9:39pm

Margaret Martin replies

Hi Nathalie,
First of all I am not a doctor I am a Physiotherapist/Physical Therapist.
If you are able to work with a Physiotherapist they may be able to help you rule out whether some of your pain is from your fibromyalgia. Try to find someone who has some training in Myofascial release.
As far as the Prolia I suggest you bring your concerns to your doctor. They are valid concerns. All the best,
Margaret

January 15, 2018 at 2:01am

vickie shanklin

I. Am 67. And have had 4 prolia shots. Since my last one in December 2017 I. Ache. Allover my back ,legs, neck, ankles,jaws,arms,wrists, what do l do now ? Everything I have read says it is not safe to go off because of fracture risk

January 16, 2018 at 10:13pm

Ann Johnstone

I would actually say, "Make sure that Prolia is safe for your bones BEFORE even having that first injection! As a nurse, I am appalled at the frequency with which Prolia is recommended to individuals who have even mild levels of osteoporosis - or sometimes only osteopaenia (where bone density levels are on the low side of normal). Prolia is being promoted in Medical Clinics as a first rather than a last resort for treatment.
Only last week I had an appointment at the medical clinic I attend, and discovered that the medical staff were all in the conference room, listening to medical sales reps extolling the benefits of Prolia! Now I am only too familiar with these tactics, as I have been present at such meetings (as a nurse), where staff are encouraged to prescribe certain new medications or treatments - and even offered incentives to do so. Sure enough, my GP came out of the conference room with a gleam in his eye, and immediately told me my bone density scan had been on the low side and so, despite the fact that I have had no fractures in years, he had decided I needed to go on Prolia. I asked him what the side effects were, and he said, "Oh well, you may have a bit of back pain - but then, the control group in most studies showed no more evidence of back pain than the placebo group. And the benefit is that you only need to have one injection every six months!" He gave me no further information before insisting I have the injection then and there.
Sadly, it wasn't until I returned home and checked out all the data online that I realized how I had been fooled! And as a health professional, I blamed myself for my naivety in agreeing to the injection. I could not believe that any doctor would recommend a treatment that had so many serious negative effects - most of which are not even discussed. For example, on Prolia, your bones are artificially remodelled because the medication blocks the growth of new bone, ensuring that old bone remains - and eventually becomes increasingly brittle. Then in many cases, completely spontaneous fractures of major bones and vertebrae can occur.
On the other hand, the medical profession should be recommending diet and exercise: Foods (including supplements, if necessary) that build bone (calcium, magnesium, Vitamins K2 and D3)... and weight bearing and strengthening exercises that promote the health and strength of bones. Sadly, I have learnt a lot over the past week via this unwelcome experience. Hopefully, others will learn more by reading this.

January 17, 2018 at 9:32pm

Margaret Martin replies

Ann, sorry to read your story but I appreciate you sharing it.
Margaret

February 15, 2018 at 2:46am

Raina

When the expert you spoke with claimed that Prolia reduces the risk of vertebral fracture by 70% and hip fracture by 40%, I think he was using relative risk reduction information from a 2009 clinical trial. These can be misleading figures.

This 2017 Clinical Resource letter indicates that while 21 women would have to be treated with Prolia for 3 years to prevent 1 vertebral fracture, its use for reducing hip fracture is much more limited as 200 women would have to be treated with Prolia for 3 years to in order to prevent just 1 hip fracture

The TI list of drugs to avoid was culled from information provided by a Prescrire letter out of Europe. The Prescrire letter suggests avoiding Strontium in addition to Prolia. The Strontium recommendation wasn't included in the Therapeutics Initiative recommendation because it isn't available as a prescription in Canada

March 1, 2018 at 6:08am

Harriet Rantoul-Hazard

Did Nina ever have a follow up bone density test? My doctor is suggesting Prolia too and I am exercising a lot and taking all the right vitamins. Can people get back to good bone density without the drugs, just with the right program? If so, do you know of a good program?

March 3, 2018 at 4:54pm

Sue .poppaw

I was on Prolia for 5 years and then he recommended going off. This was a year ago. I have been taking Bonita. My question is can I begin the prolia injections again?

March 26, 2018 at 1:56pm

Saundra Palmer

Wow! This article was so informative. Thank you.

One issue I found received little consideration. And, that was immune therapy. Have been on Prolia for three years and the last year has been horrific with rashes, hives, rosacea, and muscle and back pain.

I have been on immune therapy for 20 years and have globulin treatments every three weeks. My score is now 1,000.

My dermatologist suggested that my immune system is fighting itself. I am 80 years old and have never had such troubling side effects that even precipitate high blood pressure. So after three years of Prolia, I need a break from bone remodeling. Plan on an in-depth visit with my PCP.

What are your thoughts on the immunology treatment along with Prolia and side effects?

March 26, 2018 at 9:16pm

Margaret Martin replies

Hi Saundra,
You are most welcome. I am so sorry to hear of your terrible side effects.

It appears that the use of Prolia among persons receiving Immunology treatments is in the process of being studied. The following link is for a study that is about to begin in NZ and Australia looking at Renal and Kidney cancer patients undergoing immunotherapy as well as Prolia.
https://clinicaltrials.gov/ct2/show/NCT03280667

I will be attending several conferences in the upcoming months and will update my comment if I find out anything more.
Margaret

April 5, 2018 at 9:59pm

vickie shanklin

I been on prolia two years. My last shot was December 2017 and since then I have had pain in all my joints ,muscles, and bones. Several years ago I was on fosamax for several months and had pain all over and out of breath . I quit taking it and my doctor didn't believe me. My current doctor agrees that I should discontinue the prolia . we are going to discuss what to do next . I am now afraid of rebound fractures because of the prolia. I have never had fractures before the prolia.

April 23, 2018 at 2:41pm

Beth Morton

This drug is a biologic. It is scary. When you Google it: Prolia is not the first injectable treatment to be approved for osteoporosis, but it is the first of its kind. Unlike the other injectable treatments which are sythesized from chemicals, Prolia is a biologic, a drug that is genetically engineered from human protein.Jun 3, 2010 My Mother took 2 injections and after the 2nd one and her face got numb and she could not hear. Everyone involved at the doctor looked the other way and denied it had anything to do with Prolia. Her Primary Care doctor told her to keep taking it. Unbelievable. She stopped.

April 24, 2018 at 9:49am

Margaret Martin replies

Hi Beth,
Every individual is exactly that an "individual". It is good that your mother listened to her body and it's response to the drug.
Your quote:"Prolia is not the first injectable treatment to be approved for osteoporosis, but it is the first of its kind. Unlike the other injectable treatments which are sythesized from chemicals, Prolia is a biologic, a drug that is genetically engineered from human protein." was written by Catharine Paddock for Medical News Today dated Jun 3, 2010
Thank you for sharing our story.
Margaret

April 29, 2018 at 5:06pm

Jodell Pugsley

I have been taking Prolia shots twice yearly since I believe the inception of the drug becoming available on the market; with no known side effects. My concern has been the lack of knowledge of the health professionals who have been administering the shots and my doctor to the long term effects of continuing. This site has been very informative. I am fast approaching the 10 year mark of use and all anyone can tell me is they have never had a patient who has received the drug as long as I have, but no advice of what I do going forward. I am 64 years old women who is seemly fit and active. I supplement my diet with Calcium Citrate, Vitamin K2, multi-vitamin 3X's weekly & a prescribed Vitamin D2 50,000IU weekly. What is your advice for me and my doctor?

May 1, 2018 at 1:05pm

Richard Martin replies

Hi Jodell: Thanks for your comment. We are not in a position to give you advice on how to manage your plan with Prolia since your needs are unique to you. Only your physician is able to address this question. You might want to encourage your physician to reach out to Amgen, the manufacturer of Prolia, and ask to speak to one of their trained physicians who can discuss your situation fully.

April 30, 2018 at 2:40pm

Susan

i am 63 years of age and my doctor says I have severe Osteoporosis. I was diagnosed at 47.
I have had 7 years of Fossmax 2 years of Forteo, 2 rounds of Reclast and 2 years of Prolia.
My T- score is -3.1 with strength of bones in red. My doctor has now prescribed another round of Forteo with the continuation of the Prolia. Is this safe?

May 1, 2018 at 1:06pm

Richard Martin replies

Hi Susan: Thanks for your comment. We are not in a position to give you advice on how to manage your plan with Prolia and Forteo since your needs are unique to you. Only your physician is able to address this question. You might want to encourage your physician to reach out to Amgen, the manufacturer of Prolia, and ask to speak to one of their trained physicians who can discuss your situation fully.

May 1, 2018 at 6:02am

Mohammed Yunus

My wife aged 61, with no osteoporotic fracture history, and impaired immunity system (RA/RF positive) took her first shot of Prolia November last year. There has been no side-effects at all. As this medication is practically for life, and can have potential long term effects and escalating cost (that even today is very high) I did the following close scrutiny of the Prolia comprehensive data sheet, date of revision, May 2016, bar code no: 1014678 – that was inside the Prolia carton.
The following of its statements appeared worrisome:
1. “Prolia is indicated for treatment of postmenopausal women with osteoporosis with history of osteoporotic fracture or who have failed /intolerant to other osteoporosis therapy.” [my wife had no such history nor tried any drug beore]
2. “Patients with impaired immunity system may be at increased risk of serious infections…. Consider the benefit-risk profile in such patients before treating with Prolia.”
3. “In a large clinical trial of over 7800 women with postmenopausal osteoporosis, epidermal and dermal events such as dermatitis, eczema and rashes occurred at significantly higher rate than in the Prolia group …Consider discontinuing Prolia if severe symptoms develop.”
4. “Avoid invasive dental procedures during treatment with Prolia”
5. “In clinical trials in women with postmen. Osteoporosis, treatment with Prolia resulted in significant suppression of bone remodeling … The long term consequences of the degree of remodeling may contribute to adverse outcomes such as ostenocrosis of jaws.”
2. The following comment under ‘Clinical Trial’ heading caused me even greater alarm as I attempted to fully interpret them:
“Adverse reactions are listed below by MedDRA body system organ class and by frequency. The frequency categories based on one year event rates ( a patient under one year of Prolia medication) are”:

“Very common …… >1in 10”

“Common…………. >1-100 and < 1 in 10”.

Objective Interpretation of the above clinical trial data:
Since the data is based on one year event rate, if a patient was to remain under Prolia medication for a decade, her odds of facing adverse reaction may be 100%.
The background of this commentator is not important as he has only used the data provided in the referenced comprehensive data sheet that came with the Prolia carton. Any commentator is welcome to spot any flaw in this summary report, prepared with great caution and deliberation, though like any work of man it cannot claim to be immune to human error.
The current and potential users of Prolia must take their own decision whether to start or continue with it depending on their age and risk assessment. This commentator is advising his wife not to continue with it (not to take the second shot due in mid May) as simply because she is too young for this strong injection which is associated with so many risks as its comprehensive data sheet indicates.

May 29, 2018 at 3:42pm

Carol

I am very upset with my decision to take this medicine, I have very severe leg pain and I don't know what to do about this this. I had my first injection nearly two months ago. Please help me with a solution.

May 29, 2018 at 3:56pm

Richard Martin replies

Hi Carol: Sorry to hear about your experiences. We recommend that you work with your physician, explain to her that you have severe leg pain and work on a plan to resolve your medical issue.

May 30, 2018 at 8:37am

Glenise Panozzo

I have had my first injection of Prolia. My doctor who would be in her late 40s is taking it herself and really scared me. After As much research as I could do I very reluctantly agreed to the injection. After reading the above comments I really regret the decision and have decided not to continue with the treatment. I am in very good health,no other problems...am taking Vitamin D3 , Prunes and yogurt for breakfast and more milk than I have ever had in my life! Did you know that the caffeine in your coffee negates the benefit of the calcium in the milk in the coffee? Walking every day, climbing 102 steps on the walk and golf a couple of times per week. Fingers crossed my decision will turn out ok. Thank you so much for your most informative articles.

May 30, 2018 at 11:30am

Richard Martin replies

Hi Glenise: Thank you for sharing your experience with your fellow readers. In the blog post, Dr Adachi recommends that you work with your physician on an exit plan for Prolia. I hope that you have shared your thoughts with your physician and you are both working on your plan.

May 31, 2018 at 11:18pm

Mohammed Yunus

I have read the entire text. It is very comprehensive and gives 'more or less' a balanced take on Prolia. In one word it is not the best stuff for those in 50's and 60's even if their BMR is in Osteporosis range for these obvious reasons:

- Even with relatively high BMR, one can make a bad fall and fracture a bone.

- 2. Improvement in BMR may be at the expense of bone quality and yet to be researched long term side effects such as on sugar levels for diabetic patients – let alone increasing risk of any adverse side effects

- It is a very costly therapy: 2000 US dollar per year at present pricing - and once a patient is hooked to it he/ she must take it for at least five years (10 shots, US $ 10,000/ Besides, the manufacturers will have full freedom to steadily or steeply raise the price given the very exclusive (one may say monopolistic) character of Prolia trade. So it is not really meant for patients with limited income unless they want to depend on affluent relatives to bear the escalating cost for years together.

I have also spotted a few weak points (one may say, flaws) in the report:

- It is based on the views of only one specialist - Dr. Jonathan Adachi. I know it well that no doctor is going to give you any on any medicine (for each medicine has to be customer designed) - let alone a very strong drug like Prolia. Be it so, it remains a weakness

- There is no statistics to support the claim under Takeaway 6: “There are rare instances of Prolia injection side effects.”

- The report obscures i) the clear warnings in Prolia Leaflet as posted above by me.(May 1) and ii) Chanta Lapier’s claims (October 28) that .
i) She “gathered data from 5 websites; 375 bad reviews, 70 good.”
ii) Based on above her surgeon “decided to no longer give the Prolia shot to her patients and to recalling all those who already had it and come up with a strategy to take them off of it.”

Anyway, I am grateful to you for running the website. It has reassured me that my advice to my wife to discontinue Prolia (she took only shot in November last) was not ill-conceived. We were given merely few seconds to decide on it (say ‘yes’ or ‘no’) and cost and risk implications gradually became clear.

September 18, 2018 at 1:57am

heather

hi i just had this prolia injection and i dont wont any more of it will that be ok will i have any side effects

September 18, 2018 at 7:17am

Richard Martin replies

Hi Heather: This is a discussion you should have with your physician. The article discusses Prolia side effects and some of the potential implications of stopping Prolia treatment prematurely.

September 29, 2018 at 11:02am

Kahie

Just had my first prolia injection yesterday. My September 2018 DEXA scan indicated femur was T-1.9. I’m being treated with Anastrozole for early stage breast cancer. I was informed by my oncologist that this will help with my moderate osteopenia (“almost osteoporosis“) and help reduce my risk from a cancer recurrence. Does just one injection pose serious implications when deciding not to continue? I’m 67– walk 2 m a day, lift weights,vegan, no smoking/ drinking. Thanks for your reply.

September 30, 2018 at 9:23pm

Margaret Martin replies

Hi Kahie,
I was at a Bone Research Annual Meeting this weekend wondering the same thing and so I asked a recognized medical doctor who has written and presented about Prolia the following question:
"What do you tell someone who has changed their mind after they receive their first Prolia injection?"
Her answer was as follows:
"The indication for an osteoporotic treatment is a decision that has to be taken together with the doctor that takes care of the patient. If it is decided not to continue Prolia® after a single injection, what I can say is that all scientific evidence suggests that there is no risk for biological, densitometric or clinical (vertebral fractures risk) rebound. So if it decided to stop Prolia®, data we have suggests there is no risk concerning this secondary effect."
Please speak to your doctor about other possible choices.
All the best,
Margaret

October 1, 2018 at 12:14pm

Kathy Miller

I am trying to research how to best combat the side effects of bone density loss from Anastrozole (have to take for 5 yrs) for early stage breast cancer. I have osteopenia T-2.00, age 60, excellent health, hired a nutritionist, do weight bearing exercises. Luckily, I found this site doing research on my own before my scheduled 1st Prolia injection and told my Oncologist that I am declining his recommendation. Here is the question I can't seem to find the answer to: Is it even possible for me to keep my bones strong enough on my own for the next 5 years without drugs? And if drugs are recommended, which ones work best to protect my bones with the least side effects?

October 1, 2018 at 7:14pm

Margaret Martin replies

Hi Kathy, Weight bearing exercises is not sufficient to protect your spine. The weight bearing exercises need to be sufficiently high such as running or hiking down hills other impact loading for your hip can involve, jumps, hops, weighted squats, etc. For your spine you can find exercises in Exercise for Better Bones based on your fitness level.
I do not know the amount of bone loss that will take place due to Anatrozole. I am sure dosage will have an to be taken into account, etc. therefore I cannot answer your question about the ability to counter the effect of the drug without pharmaceuticals. SERM could be an option that you discuss with your oncologist. If you are in the USA, they may be able to monitor your bone health thru bone markers otherwise you will have to wait 18 months or so to have a repeat DXA and see what the effect is on your bones. As mentioned in the article, some physicians, like Dr. Adachi, feel that Prolia is your best bet with the least side effects. The decision is one you have to make with your oncologist. All the best.
Margaret

December 8, 2018 at 8:44am

mohammed yunus

Further to my post dated May 1 2018 tabling a set of worrisome adverse side effects data drawn on Prolia Leaflet itself, and advising my wife not to continue with it after taking her first shot mid November 2017, I am now reassured to read the following extracted from a summary research report on Prolia titled ‘Denosumab: Immune dysfunction’ dated November 2018, issued by Prescrire – an internationally recognized French Medical Journal:
“As expected from the pre-market evaluation of denosumab, reports of adverse reactions related to disruption of the immune system attributed to denosumab are accumulating. To date, several thousand cases had been recorded worldwide. Before and after its commercialisation, an increased risk of deep infections (heart, brain, bone, skin, blood) was observed with denosumab as well as an increase in cancers. Severe hypersensitivities, and sometimes serious or even fatal autoimmune disorders, have been observed.
These disruptions to the immune system are in addition to various known adverse effects of denosumab: back pain, muscle and bone pain; hypercholesterolemia, hypocalcaemia, osteonecrosis; bone disorders and atypical fractures. There is also a risk of multiple vertebral fractures when treatment is halted.
The harm-benefit balance of denosumab is clearly unfavourable in osteoporosis. It is better not to start such a treatment, which also avoids any problems related to halting it.”

December 10, 2018 at 9:24pm

Margaret Martin replies

Hi Mohammed, Thank you for sharing the research summary report from Prescrire. I was not familiar with this web site. I have found that the European doctors are much less supportive of Denusomab than the North American doctors.

March 9, 2019 at 3:11pm

Sue Berg

I wonder if there is anyone out there who has had a good experience with Prolia? I was put on it when I was 56 in 2012. I was on Boniva prior for 2 years from 2010 to 2012 because of some osteopenia. In 2012, my HIP was -2.8 though my spine was normal. No one knew anything about these meds back then. However, I never had any side effects from the Prolia. I was put on Prolia because I had been on Boniva for 2 years and it was suggested that I switch because of that -2.8 reading. My scores are now either normal or osteopenia. I have been on Prolia for 7 years. I have no pain anywhere. I am scared to get off it...one Dr. says to transition but to what? My Gyno dr. said just to stay on it. I feel that I have no choice but to stay on it. What would be the point of getting off of it? I'm assuming that those who are on Prolia and have been successful with it "reversing" their bone loss do not comment here. If anyone else has had success with Prolia, or if any doctors have patients that have done well with it, I would love to hear it. My fear is that since I have osteopenia, not osteoporosis, I may not qualify to receive Prolia and then I will suffer the consequences. I know this can be ruled by insurance companies. I have severe glaucoma, just lost my husband and am alone. The thought of suffering fractures to get off a medication that has helped me seems crazy. I have good calcium levels, walk a lot, do weight bearing exercises, etc. HAS ANYONE HAD GOOD RESULTS OTHER THAN MYSELF WITH PROLIA?

March 11, 2019 at 1:48pm

Richard Martin replies

Hi Sue, Thank you for sharing your story. Like the news, people have a tendency to report or share bad news before they share good news.
Many of my clients, are on Prolia and have been for several. Like you, they have not had any side effects from the injections. The physicians I spoke with and those interviewed for the Prolia blog recommend you stay on Prolia for 10 years, regardless of your BMD scores. The current recommendation is to transition to a bisphosphonate
You have three more years before you need to consider coming off the drug. By then they will likely have other recommendations for transitioning off.
I am sorry that you feel alone following the death of your husband. I hope you can reach out to family and friends to let them know you are lonely. Take care.
Margaret

May 5, 2019 at 4:13pm

Sandy

I have been on prolia for 6 years.
I have a tooth on the lower jaw that most likely needs to be extracted due to decay and bone loss. Two oral surgeons do not want to do the extraction due to the high risk of necrosis in the lower jaw for two reasons: (1) because the most recent prolia injection was 1 month ago and (2) because I have been on prolia for 6 years and other treatments such as Fosomax for an additional 15 years. The oral surgeon explained the efficacy of the osteoporosis drugs is about 3 years. I was told that even if I delayed the extraction for 4 months as typically recommended I am still at real risk for necrosis.
Is it correct that the benefits of Prolia would be complete in about 3 years.
Is it correct that in taking osteoporosis treatments for many years or more than 3 years increases ones risk of necrosis.

May 8, 2019 at 10:20pm

Margaret Martin replies

Hi Sandy, Your concerns and questions are very good. However, I do not know the answers. I will reach out to to Dr. Adachi who has kindly answered many questions about Prolia and get back to you.
Margaret

October 9, 2019 at 2:08pm

Jayge

Sandy I spoke with an oral surgeon regarding dental implants while on Prolia. He successfully did one four months after Prolia injection and Patient resumed his Prolia on his regular 6 month schedule.

May 9, 2020 at 10:11am

Lisa

Im not sure if this site is still active... but giving a try. I have Osteogenesis Imperfecta Type 1 and Osteoporosis. Im scheduled for first Prolia shot next week. Any thoughts and/ experience ? I am 62, have had about 30 breaks. Several post menopause including ankle, stress fracture in foot, toe, and presently a cracked rib. Do you think i should have the shot with the cracked rib?

May 9, 2020 at 10:26am

Richard Martin replies

Hi Lisa. These are very good questions. As Margaret stated in the post, the decision to take or continue with Prolia shots is one you should have with your physician. I recommend you should discuss each of your questions with your physician. Thank you for reading the article.

May 29, 2020 at 2:43pm

Donna

After two Prolia injections, I have decided to discontinue it due to side effects. (lowering my immune system and causing teeth and gum problems.) I tried Actonel, and have tried other oral meds in the past, but my stomach could not tolerate them. My doctor said there is not much more he can do for me. I am planning to continue on calcium and start more exercising and will see a physical therapist for that. I have never broken a bone prior to the Prolia. Is my risk for fractures now worse than before I started Prolia, or about the same level as it was pre-treatment?

May 29, 2020 at 3:17pm

Richard Martin replies

Hi Donna. Thank you for contacting us. You should discuss your intent to discontinue Prolia with your physician. We cannot provide guidance specific to your situation. The decision to terminate Prolia treatment should include a thorough analysis of potential implications to you and the health of your bones. This should be done with your physician.

May 30, 2020 at 1:51pm

Donna

Thank you for the response. Unfortunately, my physician has no options for me. I am trying to understand if being on Prolia a short time and getting off makes your bone density worse than when you started, or just puts you back to where you were. I was not seeking guidance as I am already off of it.

June 1, 2020 at 11:54am

Richard Martin replies

Hi Donna. You should present this question to your physician as he or she is familiar with your medical history and your response to the Prolia injections. If you are unable to discuss this topic with your physician, you might consider locating one versed in this topic and who can examine your medical history.

June 22, 2020 at 6:53am

Vicki Mackay

Hi Donna - my understanding is that, after two Prolia injections, you will need to take a relay drug to prevent possible rebound fractures from discontinuing Prolia. I had four injections and am on risedronate to get off Prolia safely. There is a 4-15% chance of fracturing without using a relay bisphosphonate.

July 14, 2020 at 2:56pm

Frances Tomcavage

So grateful for the update. I will be 88 years old in 8/2020, and have been contemplating Prolia for two years now. I ordered your book - EXERCISE FOR BETTER BONES - following many of the exercises, plus a daily walking plan 1-2 miles. As well, all the recommended vitamin supplements and excellent nutrition inclusions in my diet before, as well as during this time. Will be getting a Dexa scan in the near future to see if I am still holding at -2.5
with managing minimal discomfort from my slipped lumbar discs.

July 14, 2020 at 3:11pm

Richard Martin replies

Hi Frances. Thanks for reading the post and your comments. Congrats on your exercise and nutrition plan. Good luck with your upcoming DEXA test.

July 14, 2020 at 3:26pm

Kathy

Thanks for all this research on Prolia. Do you have information or opinion on Reclast?

July 14, 2020 at 3:28pm

Richard Martin replies

Thank you for your comment. Not at this time.

July 15, 2020 at 9:57am

Frankie

Thank you for this. I am only 30 years old and probably soon to be starting Prolia after Evenity. I was concerned about starting it because of rebound fractures but am I right in thinking even at my young age I can stay on it for life and that would be okay?

July 15, 2020 at 11:02am

Richard Martin replies

Hi Frankie. You should have this discussion with your physician. The article explains the pros and cons of Prolia and provides a template to help you have a conversation with your physician. Your age and medical history are unique to you and only your doctor will be able to provide specific guidance. Thanks.

July 19, 2020 at 10:41am

Carol Thornton

I stopped Prolia after the second injection due to side effects of rash, muscle/bone pain, skin sensitivity and worst of all was a severe stifff neck that lasted over a year. My BMD plummeted after I stopped and I mentioned a rebound effect which my dr knew nothing about. I have since had 5 spontaneous vertebral fractures (all in lower back) which research also mentions as high risk after stopping Prolia after as few as 2 injections. Some people can take this drug without known side effects but I am not one of them.

July 19, 2020 at 11:40am

Richard Martin replies

Hi Carol. Sorry to hear about you experience with Prolia and the side effects. Did you physician try moving you to a bisphosphonate after the Prolia discontinuance?

July 19, 2020 at 10:45am

Carol Thornton

In addition to above, I am now taking a supplement called *********** and exercising daily and my BMD has improved substantially.

July 19, 2020 at 11:38am

Richard Martin replies

Hi Carol. Sorry to hear about the Prolia side effects you experienced. Happy that you have committed to a nutrition and exercise program.

July 20, 2020 at 11:21am

Carol Thornton

After going against my strong intuition of not taking Prolia, and then giving into it and all the side effects I suffered, I am determined not to take any osteoporosis drugs. I am very sensitive to drugs, foods, temperatures, etc. etc. and I have GERD plus an autoimmune disease so I don't want to stress my body any more.

August 10, 2020 at 9:52am

Sandy

I am a patient of Dr. Adachi’s, am medium risk and have had 2 shots of prolia. Before having the second shot I talked to Dr. Adachi again and he stated that even though I was going to yoga twice a week, walking more than 10,000 steps a day, doing a weight training class twice a week, etc. exercise could not raise bone density as much as prolia once you have osteoporosis. I also understand that if I need to go off it and bone density returns to the numbers previous to prolia I am at a better number than if I wait. My family doctor also felt that it was much better than having a fracture. I also spoke with my dentist to make sure that nothing would make him think I would need dental surgery in the next while.
So my question is, how much difference to bone density can exercise make and would both together cover both bone density and quality?
Sandy

September 13, 2020 at 1:10pm

Margaret Martin replies

Hi Sandy, Sorry for the delay in responding. I am glad you are under Dr. Adachi's care. He is a good doctor and a kind man.
Your current activity level is one factor to take into consideration. Other things that your doctor needs to consider include hormonal status past and present, family history, food intolerances, previous fragility fracture, comorbidities, as well as past and current medications.
It sounds like you had intelligent conversations with all your health care providers and came to a decision that you are comfortable with. In the end, that is the most important thing. It helps you to sleep better at night and good sleep is one of the most important things we can do for our health.

I wish I could easily answer your question on how much difference to bone density can exercise make and would both together cover both bone density and quality. Almost all studies looking at exercise only measure the density of bone and not the quality of bone (this is due to easier access to the machines, cheaper and less radiation exposure). To this end, we have only few studies that tell us that bone quality is what makes a difference in fracture reduction. http://melioguide.com/?s=bone+quality

Exercise, when done at the right intensity and frequency does build density but as your doctors pointed out not to the same extent that strong pharmaceuticals do. Done properly exercise does not come with any of the numerous risk factors or costs that pharmaceuticals do. Pharmaceuticals will never reduce your risk of falling, make it easier for you to lift heavy items, move with more ease or improve your body mechanics. So despite taking the Prolia I hope you have maintained an active lifestyle. Thank you for taking the time to share your story.
I wish you all the best,
Margaret

September 16, 2020 at 3:03pm

Jill Burdg

Help my past doctor had me on this shot my bone destiny test improved! I went to a new dr today and he said you don’t need it I just turned 60 I have had multiple fractures since I was in my 40s I was diagnosed with osteoporosis , Now he says I don’t have it said did you get my records for past scans no,,,, I had parathyroid disease and went to the Norman Parathyroid clinic in Tampa Florida and had the tumors removed I haven’t had a injection since January what to do why is there not a dr who cares what do i was diagnosed in my mid 40s this guy said I need a drug holiday I said so your telling I have been on op meds since I was 54 for no reason then switch to prolia for the past 2 years what the heck

September 16, 2020 at 4:19pm

Richard Martin replies

Hi Jill. Sorry to hear that you have had problems with you health of recent. You should find a physician who is familiar with Prolia and understands your medical condition. Reading this article should help you with your conversation with your physician.

October 22, 2020 at 12:41pm

Grace

Thank you for the comprehensive information provided. I have been on Prolia for 3 years and my bone density has improved by almost 10%. Unlike many people who have commented on here, I have experienced minimal side effects, mainly muscular and skeletal pain during the first few weeks after injection which gradually decreases. I had been hoping it would be possible to discontinue the injections at some point if improvement continued. After reading your article I realise this would not be safe. Unfortunately, I suffer from chronic oesteoarthritis as well as oesteoporisis and find weightbearing exercise impossible. I find walking painful and try to keep fit by swimming.
If I had been better informed, I think I would not have started taking Prolia at age 65 but my doctor insisted that I had no real choice as other existing conditions narrowed my options considerably.

October 22, 2020 at 3:02pm

Richard Martin replies

Hi Grace. Thank you for sharing your experience with Prolia and your thoughts on this topic with all of us. It is much appreciated. I am sure readers will be grateful that you have been so generous.

February 28, 2021 at 9:34am

goldenknight2007

I shouldn't stop take alendronate about two years ago I when visit Dr office he say it is not late my bone are weak he say i will get prolia injection every 6 month I terrifying found out how dangerous prolia side effect. I am scared I shouldn't stop take alendronate can you tell me about ?prolia side effect I read this articles about fractures iam more terrifying I have sore and dull I don't know what to do can youhelp me

February 28, 2021 at 11:35am

Richard Martin replies

You should discuss this with your physician. You can always ask that she refer you to a specialist for professional opinion.

February 28, 2021 at 9:41am

goldenknight2007

Dr office he say it is not late. he say my bone are weak

February 28, 2021 at 11:35am

Richard Martin replies

You should discuss this with your physician. You can always ask the she refer you to a specialist for their point of view.

February 28, 2021 at 12:21pm

goldenknight2007

which physician? Endocrinology Nowak Dariusz Z MD or primary doctor dr petal