Prolia vs. Reclast

See how Prolia and Reclast compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Prolia is a twice-yearly injection while Reclast is typically a once-yearly infusion (or once every two years for prevention), so the drugs differ mainly in how often treatment is needed.

  • Prolia covers a wider range of uses, including bone loss from cancer hormone therapies, while Reclast is the only one of the two approved for Paget's disease of bone.

  • Stopping Prolia without switching to another antiresorptive can cause rebound vertebral fractures, while Reclast's bone-bound effect tapers off gradually after the last dose.

Prolia vs. Reclast Drug Summary

Prolia

Prolia (denosumab) is a RANK ligand inhibitor given as a subcutaneous injection by a healthcare provider once every six months. It is approved to treat osteoporosis in postmenopausal women, men, and people at high fracture risk from long-term steroid use or certain cancer hormone therapies.

Reclast

Reclast (zoledronic acid) is a bisphosphonate given as an intravenous infusion, typically once a year for osteoporosis treatment or once every two years for prevention. It is also approved to treat glucocorticoid-induced osteoporosis and Paget's disease of bone.

Prolia vs. Reclast 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%)

Reclast

Most common
myalgia (up to 17.1%)
fever (up to 15.7%)
fatigue (up to 12.4%)
arthralgia (up to 11.1%)

Prolia vs. Reclast Dosage

Prolia

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 60 mg every 6 months At the start
Maximum dose 60 mg every 6 months Same as starting
Dose changes None Fixed dose

Reclast

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 5 mg IV infusion At the start
Maximum dose 5 mg IV infusion Same as starting
Dose changes None Fixed dose

Prolia vs. Reclast Indications

Prolia

Prolia treats osteoporosis by blocking RANK ligand, a protein involved in bone breakdown, and is given as an injection every six months. Its FDA approval covers a wide range of high-fracture-risk groups, including people losing bone density from cancer treatment.

  • Postmenopausal women with osteoporosis at high fracture risk

  • Men with osteoporosis at high fracture risk

  • Glucocorticoid-induced osteoporosis in men and women

  • Bone loss from androgen deprivation therapy in prostate cancer

  • Bone loss from aromatase inhibitor therapy in breast cancer

Reclast

Reclast treats osteoporosis with a bisphosphonate infusion given once a year, or once every two years to prevent postmenopausal osteoporosis. Its approval also extends to Paget's disease of bone, a use Prolia does not share.

  • Treatment of postmenopausal osteoporosis

  • Prevention of postmenopausal osteoporosis

  • Osteoporosis in men

  • Treatment and prevention of glucocorticoid-induced osteoporosis

  • Paget's disease of bone

Prolia vs. Reclast Pros and Cons

Prolia

Prolia's twice-yearly injection and broad label, including bone loss from cancer hormone therapy, offer flexibility, but stopping it without follow-up therapy can trigger rebound vertebral fractures. It also carries a boxed warning for hypocalcemia in advanced kidney disease.

Pros

  • Approved for bone loss caused by aromatase inhibitors and androgen deprivation therapy

  • Quick subcutaneous injection, no IV line or infusion time needed

  • No routine pre-dose hydration or renal clearance check required

  • Fewer patients report flu-like acute-phase symptoms than with Reclast

Cons

  • Must be dosed exactly every 6 months to avoid gaps in protection

  • Stopping without a follow-up antiresorptive can cause rebound vertebral fractures

  • Carries a boxed warning for severe hypocalcemia in advanced kidney disease

  • Not approved for Paget's disease of bone

Reclast

Reclast's once-yearly, or less frequent, infusion covers standard osteoporosis care and Paget's disease, but it commonly causes flu-like symptoms in the days following infusion and is not recommended for patients with significant kidney impairment.

Pros

  • Dosed only once a year for treatment, or once every 2 years for prevention

  • Also FDA-approved for Paget's disease of bone

  • Effects taper gradually after stopping, without the rebound fracture risk seen with Prolia

  • No boxed warning for hypocalcemia; risk is managed with pre-treatment calcium correction

Cons

  • Common flu-like acute-phase reaction (fever, myalgia, arthralgia) after infusion

  • Requires a 15-plus minute IV infusion visit rather than a quick injection

  • Contraindicated in patients with significant kidney impairment (CrCl under 35 mL/min)

  • Not approved for bone loss from cancer hormone therapies

Common Symptoms and Related Diseases You Can Explore

Explore a range of common symptoms the Doctronic Symptom Checker can help you understand.