Prolia vs. Forteo
See how Prolia and Forteo compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Prolia is a twice-yearly injection that slows bone breakdown, while Forteo is a daily self-injection that builds new bone.
Prolia carries a boxed warning for severe hypocalcemia in advanced kidney disease, and stopping it without follow-up therapy can trigger rebound spine fractures.
Forteo's boxed warning for osteosarcoma risk was removed from its label in 2021, but its use is still capped at two years total.
Prolia vs. Forteo Drug Summary
Prolia
Prolia (denosumab) is a RANK ligand (RANKL) inhibitor that slows bone breakdown in people with osteoporosis at high risk of fracture. It's given as a single injection under the skin every six months, administered by a healthcare provider during an office visit.
Forteo
Forteo (teriparatide) is a parathyroid hormone analog that stimulates the body to build new bone rather than just slowing bone loss. It's self-injected under the skin once a day using a prefilled pen, typically for up to two years total.
Prolia vs. Forteo Side Effects
Prolia
Forteo
Prolia vs. Forteo Dosage
Prolia
Forteo
| 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 | 20 mcg once daily | At the start |
| Maximum dose | 20 mcg once daily | 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 |
Forteo
| STAGE | DOSE | WHEN |
| Starting dose | 20 mcg once daily | At the start |
| Maximum dose | 20 mcg once daily | Same as starting |
| Dose changes | None | Fixed dose |
Prolia vs. Forteo Indications
Prolia
Prolia is FDA-approved for several osteoporosis-related conditions, including postmenopausal women and men at high risk of fracture. It's also approved for bone loss linked to certain cancer treatments and long-term steroid use.
Postmenopausal women with osteoporosis at high risk of fracture
Men with osteoporosis at high risk of fracture
Glucocorticoid-induced osteoporosis in men and women
Bone loss from androgen deprivation therapy for prostate cancer
Forteo
Forteo is FDA-approved to treat osteoporosis in postmenopausal women and men at high risk of fracture, including those with primary or hypogonadal osteoporosis. It's also approved for glucocorticoid-induced osteoporosis in men and women at high risk of fracture.
Postmenopausal women with osteoporosis at high risk of fracture
Men with primary or hypogonadal osteoporosis
Glucocorticoid-induced osteoporosis in men and women
Not approved for patients with open growth plates
Prolia vs. Forteo Pros and Cons
Prolia
Prolia's twice-yearly dosing means far fewer injections than Forteo's daily regimen, and it covers a broader range of patients, including those on cancer-related hormone therapy. It requires an in-office visit for each dose and carries specific warnings tied to kidney function and stopping treatment.
Pros
Only two injections per year instead of a daily shot
Approved for bone loss from hormone therapies used in cancer treatment
Administered by a healthcare professional, no self-injection needed
Roughly $1,600 to $2,000 per injection, needed only twice a year
Cons
Requires an in-office visit for every dose
Boxed warning for severe hypocalcemia in advanced kidney disease
Stopping without follow-up therapy can trigger rebound spine fractures
Risk of osteonecrosis of the jaw and atypical femur fractures
Forteo
Forteo builds new bone rather than just slowing its breakdown, which can appeal to patients with more severe osteoporosis or prior fractures. It requires a daily self-injection and is limited to two years of lifetime use under current FDA labeling.
Pros
Builds new bone rather than only slowing its breakdown
Self-administered at home, no clinic visit required
Osteosarcoma boxed warning removed from the label in 2021
No kidney-related boxed warning like Prolia's
Cons
Requires a daily injection rather than twice a year
Limited to two years of total use under current FDA labeling
Roughly $4,590 to $5,100 per month without insurance, before savings programs
Avoid in patients with certain bone conditions like Paget's disease
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