Prolia vs. Evenity
See how Prolia and Evenity compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Prolia is injected twice a year and covers more osteoporosis indications, including men and people on steroids, while Evenity is approved only for postmenopausal women.
Evenity is the only drug that builds new bone and slows bone loss at the same time, but its use is capped at 12 monthly doses over a lifetime.
Evenity carries a boxed warning for heart attack, stroke, and cardiovascular death, while Prolia's boxed warning concerns severe low calcium in advanced kidney disease.
Prolia vs. Evenity Drug Summary
Prolia
Prolia (denosumab) is a RANK ligand inhibitor, a monoclonal antibody that slows bone breakdown, used to treat osteoporosis in postmenopausal women, men, and people with bone loss from steroids or certain cancer therapies. It is given as a single injection under the skin once every six months by a healthcare provider.
Evenity
Evenity (romosozumab-aqqg) is a sclerostin inhibitor, a monoclonal antibody that both builds new bone and reduces bone breakdown, approved for postmenopausal women with osteoporosis at high risk for fracture. It is given as two injections under the skin once a month, for a maximum of 12 doses in a patient's lifetime.
Prolia vs. Evenity Side Effects
Prolia
Evenity
Prolia vs. Evenity Dosage
Prolia
Evenity
| STAGE | DOSE | WHEN |
| Starting dose | 60 mg | At the start |
| Maximum dose | 60 mg | Same as starting |
| Dose changes | None | Fixed dose |
| STAGE | DOSE | WHEN |
| Starting dose | 210 mg | At the start |
| Maximum dose | 210 mg | Same as starting |
| Dose changes | None | Fixed dose |
Prolia
| STAGE | DOSE | WHEN |
| Starting dose | 60 mg | At the start |
| Maximum dose | 60 mg | Same as starting |
| Dose changes | None | Fixed dose |
Evenity
| STAGE | DOSE | WHEN |
| Starting dose | 210 mg | At the start |
| Maximum dose | 210 mg | Same as starting |
| Dose changes | None | Fixed dose |
Prolia vs. Evenity Indications
Prolia
Prolia is approved for a wide range of osteoporosis-related conditions, including postmenopausal women, men, and people with bone loss caused by steroids or cancer treatment. It is typically used long-term, with injections continuing every six months for as long as fracture risk remains high.
Postmenopausal women with osteoporosis at high risk for fracture
Men with osteoporosis at high risk for fracture
Glucocorticoid-induced osteoporosis in men and women
Men on androgen deprivation therapy for prostate cancer
Evenity
Evenity is approved only for postmenopausal women with osteoporosis who are at high risk for fracture, based on a prior fracture, multiple risk factors, or a lack of response to other treatments. Treatment is limited to one year of monthly injections, after which patients typically switch to a drug like Prolia to maintain the bone gains.
Postmenopausal women with osteoporosis at high risk for fracture
History of a prior osteoporotic fracture
Multiple risk factors for fracture
Failure or intolerance to other osteoporosis therapies
Prolia vs. Evenity Pros and Cons
Prolia
Prolia has a long track record since its 2010 approval and covers the broadest range of osteoporosis indications, including men and steroid-induced bone loss. Its main risks are rare but serious, including jaw bone problems and a rebound fracture risk if doses are missed or treatment is stopped abruptly.
Pros
Injected only twice a year, one of the least frequent schedules in osteoporosis treatment
FDA-approved for men, glucocorticoid-induced osteoporosis, and cancer-related bone loss, not just postmenopausal women
No boxed warning for cardiovascular events
Cons
Carries a boxed warning for severe low calcium in patients with advanced kidney disease
Stopping treatment without follow-up therapy can trigger rebound vertebral fractures
Linked to jawbone problems and unusual thigh bone fractures with long-term use
Must be administered by a healthcare professional, never self-injected at home
Evenity
Evenity is the only drug that builds new bone while also slowing its breakdown, which can make it a strong option for patients at very high fracture risk. Its cardiovascular boxed warning and one-year treatment cap mean it is usually used for a defined course before switching to a maintenance therapy.
Pros
Only FDA-approved therapy that both builds new bone and blocks bone breakdown
Treatment is capped at 12 monthly doses, giving a clear, defined stopping point
Once-monthly injections offer a more frequent, consistent dosing rhythm
Cons
Carries a boxed warning for increased risk of heart attack, stroke, and cardiovascular death
Not approved for men, premenopausal women, or women who may become pregnant
Requires two separate injections at every monthly visit
Roughly $1,825 to $2,629 per month before insurance or savings programs, a higher ongoing cost than Prolia's twice-yearly dosing
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