Prolia treatment for osteoporosis

Posted by Veruska @veriska, Mar 7, 2017

I received the results from my bone test and they have recommended I start Prolia. I have read the side effects and I am concerned. Has anyone use this drug and if so what side effects have you experienced. Thank you

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@windyshores

@callalloo the two you mentioned were taking bisphosphonates for "well over 10 years." Are people taking bisphosphonates that long? This raises the issue of when to start a medication, since time might seem to run out if started too young. One year Evenity, two years anabolic, ten years total for Prolia and bisphosphonates, for instance, equals 13 years. So if one starts at 60, what happens at 73? I am curious if anyone's doc has discussed this, of if many are actually taking anti-resorptives for longer than 10 years.

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I think there are a lot of people who've taken bisphosphonates for over a decade, especially people who started on Fosamax when it was first approved and just stayed on them because there were no known long-term effects for many years. And no alternatives beyond Boniva. At least that's my impression from what I've seen people mention, including some who've posted on Mayo Connect. Merck introduced Fosamax for older women and then sold bone-screening equipment to medical facilities to help generate sales of Fosamax. But then younger women started getting prescribed Fosamax and stayed on it for a long time if they tolerated it. The idea of planning a sequence of treatments, over time, is new, concurrent with newer choices from what I gather.

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@windyshores

Forteo and Tymlos improve bone quality since they don't affect resorption/turnover. I would assume Evenity does too to an extent though it does affect resorption, to a lesser degree that Prolia or biphosphonates.

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I understand the sequence that Amgen is suggesting of Evenity to build bone, then Prolia to "protect it" but can't understand why that would work if Prolia is an anti-resorptive drug. Does it not have the same risk of longitudinal fractures that the bisphosphonates have?

PS One study I came upon suggested that a possible reason for BRONJ is that the jaw bone sheds and replenishes bone cells faster than the major large bones of the body. Therefore the anti-resorptives mechanism of preventing the normal shedding of dead cells impacts the jaw bone differently.

PPS I don't understand why some of the osteoporosis drugs help the lumbar spine but not the femur/hip and others do the exact opposite. Or why bisphosphonates can cause longitudinal femur fractures for that matter. I've read a lot of studies but have yet to come upon an explanation for that unintended consequence.

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@callalloo

I understand the sequence that Amgen is suggesting of Evenity to build bone, then Prolia to "protect it" but can't understand why that would work if Prolia is an anti-resorptive drug. Does it not have the same risk of longitudinal fractures that the bisphosphonates have?

PS One study I came upon suggested that a possible reason for BRONJ is that the jaw bone sheds and replenishes bone cells faster than the major large bones of the body. Therefore the anti-resorptives mechanism of preventing the normal shedding of dead cells impacts the jaw bone differently.

PPS I don't understand why some of the osteoporosis drugs help the lumbar spine but not the femur/hip and others do the exact opposite. Or why bisphosphonates can cause longitudinal femur fractures for that matter. I've read a lot of studies but have yet to come upon an explanation for that unintended consequence.

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Forteo has been around for quite a long time. I believe I tried to get on it 15 years ago. The FDA approved it in 2001, 20 years ago.

The problem is that primary care doctors think the biphosphonates are the "first line." They still do. They don't realize this is guided by insurance companies who want to avoid the expensive anabolics. Which may not work as well after all those years on anti-resorptives.

Amgen makes both Evenity and Prolia so it is no surprise they are suggesting that sequence. I am fortunate that my doc is using Reclast, possibly partial dose and possibly with breaks, with monitoring. Breaks are impossible with Prolia.

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@barblonghofer

Can you share more about this "copay card". thank you.

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I haven't contacted the company yet (I am just considering the medication at this time), but if you go to the Prolia website, you can find out more information:
http://www.proliasupport.com/patient-overview. My insurance company will charge me a copay of at least $1000 per infusion.

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