How it Works

Denosumab is a bone-strengthening monoclonal antibody that inhibits the Rank Ligand. It works differently from other bone-strengtheners.

In bone formation, there are bone-creating cells (osteoblasts) and bone-eating cells (osteoclasts). New bone is formed at the same rate old bone is destroyed in healthy individuals. Multiple myeloma causes greater bone destruction that is not balanced with new bone formation, leading to bone lesions and fractures. Denosumab neutralizes one of the proteins that cause bone-eating cells to be active, decreasing bone destruction.

Xgeva vs Prolia

Xgeva and Prolia, Denosumab brand names made by Amgen, differ in their indications, the way they are given, and their dosage. People who are receiving Prolia should not receive Xgeva and the converse is also true. While Xgeva is indicated for bone loss and calcium increase related to a malignant disease, like Multiple Myeloma, Prolia is indicated for bone loss related to osteoporosis and other diseases that cause hormonal dysregulations.

How it’s Administered

Denosumab is given as a 120mg shot under the skin every four weeks. It can be injected into your upper arm, upper thigh, or stomach area. This is a convenient way to receive a bone strengthener compared to bisphosphonates, which require IV administration.

Denosumab is given for an extended period to protect the bones. 

Before you start taking Denosumab, please have your dentist provide you with all the necessary care. You should also let your doctor know that you are taking Denosumab as this medication can cause a condition called osteonecrosis of the jaw (ONJ). You should receive oral calcium and vitamin D to treat or prevent low calcium levels (hypocalcemia).

Who Should Take Denosumab

Denosumab (Xgeva ®) is currently approved for:

• Patients who need a bone strengthener to protect their bones against multiple myeloma or other types of cancer that have spread to the bone
• Patients who are resistant to bisphosphonates
• Patients who have hypercalcemia (high calcium) caused by cancer that hasn’t responded to bisphosphonates.
• Patients with renal failure

Who Shouldn’t Take Denosumab

• Patients with low calcium levels.
• Patients on Prolia should not take Denosumab as it is the same medicine as Prolia. 

If You Stop Taking Denosumab

If your doctor decides to discontinue Denosumab, you will need to receive at least one dose of a bisphosphonate bone strengthener to prevent bone damage due to a sudden increase in bone-eating cells (osteoclasts) activity. 

Possible Side Effects

The most common side effects of taking Denosumab include:

• Nausea
• Low blood platelets
• Low calcium
• Back pain
• Swelling of lower legs or hands
• Upper respiratory tract infection
• Rash
• Headache
• Pneumonia
• Osteonecrosis of the jaw (ONJ)

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