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

Most common
back pain (up to 34.1%)
pain in extremity (up to 11.4%)
musculoskeletal pain (up to 7.4%)
hypercholesterolemia (up to 7.2%)

Forteo

Most common
pain (up to 21.3%)
arthralgia (up to 10.1%)
asthenia (up to 8.7%)
nausea (up to 8.5%)

Prolia vs. Forteo Dosage

Prolia

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 60 mg At the start
Maximum dose 60 mg Same as starting
Dose changes None Fixed dose

Forteo

Dosage
Dosage Table
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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