The FDA has approved Prolia for men with osteoporosis, who are “at high risk for fracture”. This affects a sizeable number of men. High fracture risk includes men with crumbling spine “humpback” vertebral fractures (kyphosis), other fractures (especially hip), inhaler and other steroid use, parental history of fractures, and smoking. See the posts about these topics and FRAX.
Prolia is especially useful in individuals with Heartburn or Reflux Disease (GERD) and decreased kidney function, including many older individuals with older, tired kidneys. Women have had Prolia available since 2010. Having this additional option for men is important.
Prolia (Denosumab) is different type of Antiresorptive from the Bisphosphonates: Fosamax, Alendronate, Actonel, Boniva, Ibandronate, and Reclast. It does not accumulate in bone. It is totally gone from the body within 12 months of the last shot. It does not affect the kidneys, so renal function (GFR) is not an issue.
Prolia is a shot under the skin twice a year. Heartburn and other digestive issues do not exist with a shot. Insurances (including Medicare) require it be given as an outpatient, usually in a doctor’s office.
Prolia acts by mimicking natural osteoprotegrin (OPG) which inhibits RANK-Ligand to keep Oseoclast formation and activation under control. Prolia can initially shut down about 85% of the osteoclast ability to gobble up bone and raise serum calcium. Therefore testing for PTH, 25-hydroxy Vitamin D, and serum calcium is needed before choosing your osteoporosis medication.
Remember that you must have enough Vitamin D (40 to 80 ng/ml) and enough Calcium intake (1200 to 1500 mg daily) for Prolia or any other osteoporosis medication to work.
Jay Ginther, MD