Denosumab: A Treatment for Osteoporosis and Bone Metastases

Denosumab is a type of targeted therapy called a monoclonal antibody. It is made in the laboratory to recognise and find specific proteins on the outside of some cells.

Denosumab works by binding to a protein called RANKL, which is involved in the formation and function of osteoclasts, the cells that break down bone. By blocking RANKL, denosumab prevents osteoclasts from resorbing bone, thus increasing bone mass and reducing the risk of fractures.

Denosumab has two trade names: Prolia and Xgeva. Prolia is used for the treatment of osteoporosis, bone loss due to certain medications, and giant cell tumor of bone. Xgeva is used for the prevention of skeletal-related events (such as bone fractures and pain) in patients with multiple myeloma and in patients with bone metastases from solid tumors.

How to use denosumab

Denosumab is given as a subcutaneous injection (under the skin) every 4 to 6 months, depending on the indication. The dose is 60 mg for Prolia and 120 mg for Xgeva.

Before starting denosumab, you should have your blood calcium level checked and take calcium and vitamin D supplements as prescribed by your doctor. This is because denosumab can lower your blood calcium level and cause hypocalcemia, which can lead to serious complications such as muscle spasms, seizures, and heart problems.

You should also have regular dental check-ups and maintain good oral hygiene while using denosumab. This is because denosumab can increase the risk of osteonecrosis of the jaw, a condition where the jaw bone becomes damaged and does not heal properly. This can cause pain, infection, and tooth loss.

Side effects of denosumab

The most common side effects of denosumab are joint and muscle pain in the arms or legs. These usually occur within the first few days after the injection and are mild to moderate in severity. They usually go away within a few weeks.

Other possible side effects of denosumab include:

  • Infections such as cellulitis, urinary tract infections, ear infections, and skin infections. You should contact your doctor if you have signs of infection such as fever, chills, redness, swelling, or pain.
  • Atypical femur fractures, which are rare but serious breaks in the thigh bone that can occur with minimal or no trauma. You should contact your doctor if you have new or unusual pain in your hip, groin, or thigh.
  • Hypersensitivity reactions such as rash, itching, hives, swelling of the face or throat, difficulty breathing, or low blood pressure. You should seek immediate medical attention if you have any of these symptoms after receiving denosumab.

Price comparison of denosumab

The following table shows the average price of denosumab per injection in different countries as of September 2023. The prices are based on online sources and may vary depending on the pharmacy, insurance coverage, and other factors.

CountryProlia (60 mg)Xgeva (120 mg)Reference

Top 5 global brands of denosumab

The following list shows the top 5 global brands of denosumab based on the market share and revenue in 2022. The list is based on a report by GlobalData.

  1. Prolia by Amgen
  2. Xgeva by Amgen
  3. Evenity by Amgen and UCB
  4. Denosumab Biosimilar by Sandoz
  5. Denosumab Biosimilar by Coherus


Denosumab is a monoclonal antibody that binds to RANKL and prevents bone resorption. It is used for the treatment of osteoporosis, bone loss due to certain medications, bone metastases, and giant cell tumor of bone. It is given as a subcutaneous injection every 4 to 6 months. It can cause side effects such as hypocalcemia, infections, osteonecrosis of the jaw, and atypical femur fractures. The price of denosumab varies depending on the country and the brand. The top 5 global brands of denosumab are Prolia, Xgeva, Evenity, and two biosimilars.


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