Denosumab (Prolia, Xgeva)
Denosumab (Prolia, Xgeva) is a prescription medication used to treat osteoporosis, a condition in which bones become weak and more likely to break (fracture). It is also used to prevent bone loss in certain people receiving steroid therapy or cancer-related hormone treatments.
Denosumab is a biologic medication that works by blocking a protein called RANK ligand (RANK-L), which normally activates cells that break down bone (osteoclasts). By slowing bone breakdown, denosumab helps improve bone strength and lowers the risk of fractures.
How To Take It
Denosumab is given as a subcutaneous (under the skin) injection by a healthcare provider in a clinic, infusion center, or medical office. The usual dose for osteoporosis is 60 mg every 6 months.
People taking denosumab should usually take calcium (1,000–1,200 mg daily) and vitamin D (at least 400–800 IU daily), unless otherwise directed by their healthcare provider. Calcium and vitamin D levels should be checked before starting treatment and monitored periodically during therapy.
Blood tests are recommended before each injection, especially in people with kidney disease or low calcium levels. Bone density testing is generally repeated every 1–2 years to monitor treatment response.
A dental examination is recommended before starting denosumab, especially for patients with poor dental health, gum disease, dentures, or planned dental procedures.
Side Effects
The most common side effects of denosumab include muscle, joint, or back pain, pain in the arms or legs, fatigue, elevated cholesterol levels, and mild skin rash or eczema. Some people may experience severe bone, joint, or muscle pain that can last for days, weeks, or longer.
Denosumab can cause low blood calcium levels (hypocalcemia), especially in people with advanced chronic kidney disease or those on dialysis. Symptoms may include muscle cramps or spasms, tingling or numbness around the mouth, hands, or feet, and in rare cases confusion or seizures. Because of this risk, the FDA added a boxed warning for severe hypocalcemia in patients with advanced kidney disease.
Rare but serious complications may also include osteonecrosis of the jaw (loss of blood supply to the jawbone), atypical femur fractures (unusual thigh bone fractures), and severe allergic reactions such as rash, hives, swelling, or difficulty breathing.
Stopping, delaying, or missing denosumab doses may lead to rapid bone loss and increase the risk of multiple vertebral (spine) fractures. If denosumab must be stopped, another osteoporosis medication is usually recommended to help reduce this risk.
Tell Your Rheumatology Provider
If you are pregnant, considering pregnancy, or breastfeeding, let your provider know before starting this medication. Birth control is recommended for people who can become pregnant while taking denosumab and for at least 5 months after the last dose. Breastfeeding is not recommended while on denosumab because the drug can enter breast milk.
If you are taking denosumab, call your provider if you have numbness or tingling of the hands or around the mouth, muscle twitches or spasms, new pain in the jaw or thigh, hip, or groin; burning or discomfort with urination or needing to urinate urgently, and fevers or other signs of infection. If you need any dental procedures, let your doctor know that you are on denosumab as you may need to stop or delay the treatment.
Updated May 2026 by Howard Yang, MD, RhMSUS, and reviewed by the American College of Rheumatology Communications and Marketing Committee.
This information provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.