How long can you take Prolia injections and are there any risks of discontinuing the medication? I asked Dr. Jonathan Adachi — one of Canada’s leading osteoporosis experts. He stated that you should plan on being on Prolia for at least ten years. He also told me that you should have a clear plan with your physician on how to terminate your use of Prolia injections since a sudden stop in usage of the drug can have significant side effects.
In the video below 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 as very effective) could lead to incidence of vertebral fracture. I also provide suggestions to you in case you are either on Prolia or are planning to start treatment with this medication.
What is Prolia?
It interferes with the protein RANK ligand (RANKL) and prevents the formation, maturation and survival rates of osteoclasts. Prolia prevents the formation and maturation and survival rates of osteoclasts. Prolia affects the whole remodelling of bone.
Prolia is similar in mechanism of action to the bisphosphonates (that most people are familiar with) but Prolia works on the immune system whereas bisphosphonates are more of a chemical interaction.
It has been shown to be very effective when compared to bisphosphonates, but it is not as strong a medication as Forteo.
There have been several large studies showing significant benefits, both to fracture rates and improvements in bone density. It’s been compared in one study to the bisphosphonate Alendronate and again it’s shown superior results in fracture and bone density to the bisphosphonates.
AMGEN, the manufacturer of Prolia, states that the drug is for women with postmenopausal osteoporosis at high risk for fracture.
Now that you know what Prolia is, let us explore some new research on Prolia side effects (especially related to prematurely discontinuing the use of Prolia) and answer the question how long can you take Prolia?
Prolia Injection Side Effects
Hi, I’m Margaret Martin at MelioGuide.
Welcome back, and today’s part two on pharmacotherapy in regards to certain drugs. Specifically, I’m going to talk about denosumab, or Prolia.
After the last blog, I received emails and phone calls from many of my listeners and readers, and so I decided to just look a little bit deeper into Prolia, and there has been some words of caution coming out of a group in Switzerland.
Potential Risks of Discontinuing Prolia Injections
In the Spring of 2016, a research team from Switzerland presented at the annual Endocrinology Conference.
They presented case studies within their practice. In the case studies they had seven women who had been put on Prolia.
Some of the women had just received two to four injections. Some of them were not on Prolia for very long because, similar to many of my readers, you’re put on Prolia and then your doctor goes, “Oh, wow, your numbers have gone up, Prolia’s been very effective, you can come off of it.”
What the researchers were noticing in their practice is that when people were coming off of Prolia (within 9 to 16 months of discontinuing Prolia) that they were fracturing and getting numerous fractures of their vertebrae.
They presented in this one paper that amongst seven women, they had 28 fractures. When they re-presented the paper a half-a-year later in the Fall of 2016, they had nine women, with on average, five-and-a-half fractures per individual.
How Long Can You Take Prolia
In case you didn’t read all the details of my first blog on pharmacotherapy, Dr. Adachi stated, “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.”
I hope this helps you in making a decision in your treatment choice.
Should You Take and Osteoporosis Medication such as Prolia?
Many women do not make their bone health a priority until a life event, such as a diagnosis of osteoporosis, forces a change and they find that they have to take an osteoporosis medication such as Prolia or Forteo. The decision to take an osteoporosis medication such as Prolia is a serious 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.
1. 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 ordered a bone mineral density (BMD) test for Nina.
The results came back and they were not good. Nina’s bone density was lower than he anticipated. As a result, her physician prescribed an osteoporosis medication to increase her bone density.
2. 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 serious side effects that made her uncomfortable.
Pharmaceuticals may be appropriate for individuals in urgent need of an increase in bone density. 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.
3. 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.
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!
4. 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.
5. 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.
6. 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.
- 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
- 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.
For more information, check out my Osteoporosis Guidelines.