Prolia

Prolia is the brand name for denosumab, a human monoclonal antibody used to treat osteoporosis and other bone-loss conditions. It is administered by subcutaneous injection and given as 60 mg every six months. Denosumab is also used to treat glucocorticoid-induced osteoporosis in adults. It works by binding RANKL, a key mediator of osteoclast formation and activity. By neutralizing RANKL, denosumab decreases the formation, function, and survival of osteoclasts, reducing bone resorption and increasing bone mineral density. This leads to a reduced risk of vertebral and other fragility fractures.

Prolia is indicated for the treatment of osteoporosis in postmenopausal women at high risk of fracture, for osteoporosis in men at increased risk of fracture, and for glucocorticoid-induced osteoporosis in adults. It is not approved for the prevention of cancer-related bone disease; a higher-dose formulation (Xgeva) is used for that indication.

Administration and monitoring: The dose is 60 mg subcutaneously every six months, usually after ensuring adequate calcium and vitamin D intake. No dose adjustment is typically required for renal impairment, but hypocalcemia risk is higher in CKD; correction of calcium and vitamin D is essential before starting. Common adverse effects include back and joint pain; more serious risks include hypocalcemia, osteonecrosis of the jaw, and rare atypical femoral fractures. Infections have been reported rarely. Discontinuation may cause rebound increases in bone turnover and rapid loss of BMD; after stopping, transitioning to another antiresorptive therapy may be considered. Regular monitoring of calcium levels, dental health, and DXA bone density is recommended.