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    An_223985 posted:
    My doctor has prescribed Prolia. I just completed 2 years on Forteo, is anyone out there on Prolia? I've read the warnings and it sounds like it may be trouble. How have any of you who have been on Prolia feel and what can I expect?
    Louise_WebMD_Staff responded:
    I don't know anyone with personal experience yet. I do have this information though:

    FDA approves Prolia for High Risk Osteoporosis

    A paragraph in another article about Osteoporosis Treatments : "Prolia is a so-called monoclonal antibody -- a fully human, lab-produced antibody that inactivates the body's bone-breakdown mechanism. It's the first "biologic therapy" to be approved for osteoporosis treatment . Prolia is approved for postmenopausal women with osteoporosis and high risk of fracture, and when other osteoporosis medicines have not worked."

    The thing to remember is that your doctor feels the benefits outweigh the risks. Did you ask your doctor why they chose this drug?

    Also, what meds you have tried in the past and tell us about your current condition.
    Susan Randall, RN, FNP-BC, MSN responded:
    Below is information from NOF about denosumab (Brand name Prolia). Dr. Michael Lewiecki posted an excellent discussion a while back called "Balancing the Benefits and Risks of Osteoporosis Treatment ." This discussion may help you in your decision making process.

    In June 2010, Denosumab was approved by the FDA for the treatment of osteoporosis in postmenopausal women at high risk of fracture or breaking a bone. According to the package insert, being at high risk of fracture means that you meet one or more of the following conditions:

    -you have already broken a bone from osteoporosis
    -you have several risk factors for breaking a bone
    -you have not been able to take other osteoporosis medicines due to side effects
    -you have not received enough benefit from other osteoporosis medicines

    Denosumab is a RANK ligand (RANKL) inhibitor/human monoclonal antibody. A healthcare professional gives denosumab by injection every six months. Patients need to have a blood test before each dose to confirm that blood calcium level is normal. As for all people with osteoporosis, it is very important to get enough calcium, vitamin D and exercise every day.

    In clinical trials, denosumab significantly reduced the incidence of new spine fractures by 68 percent, reduced the incidence of hip fractures by 40 percent and reduced the incidence of all non-spine fractures by 20 percent over three years.

    Side Effects

    Denosumab may lower the calcium levels in the blood. If blood calcium levels are low before receiving denosumab, the low calcium level must be corrected before giving the medicine or it will get worse. Signs of low calcium levels include spasms, twitches or cramps in the muscles; or numbness and tingling in the fingers, toes or around the mouth. If any of these symptoms are seen while on this medicine, patients should contact their healthcare provider. Most patients with low calcium levels, however, do not show these signs.
    People who have weak immune systems or take other medicines that affect the immune system may have an increased chance of having serious infections with denosumab. Even patients who have no immune system problems may be at higher risk of certain infections such as those of the skin. Patients should contact their healthcare provider right away if signs of infection occur. These signs may include fever, chills, red and swollen skin, skin that is hot or sore to the touch, severe pains in the abdomen, or pain or burning when passing urine or passing urine more frequently and in small amounts.

    Denosumab may also cause skin rashes. Call your healthcare provider if you notice any abnormal skin-related symptoms. Denosumab has caused osteonecrosis of the jaw (ONJ) when used to treat patients with cancer although at this time, these have not been seen in patients with osteoporosis. Patients should practice good dental care during treatment and should have an examination of the mouth by a doctor or dentist before starting the medicine.

    Other side effects can include back pain and musculoskeletal pain in the arms and legs.
    Yoliz replied to Louise_WebMD_Staff's response:
    Greetings- to answer your questions: The doctor recommended Prolia to maintain the bone mass gained while on Forteo for 2 years. My bone density has improved significantly, between an exercise routine 4 days per week, and walking on the weekends, plus calcium & iron supplements AND the Forteo he felt that Prolia would be the best way to maintain the bone density.

    I have have never had a fracture or any kind or balance problems ever, and I found out yesterday that Prolia costs over $1,000 per injection. There are 2 injections per year. With my insurance coverage I will have to pay $150 per injection. I did have my calcium level checked and am waiting for the results.

    I was on Actionel and it was ineffective. I am 63 and am 5'9" and weight 130 lbs. While on Forteo it was recommended that I not weigh less than 127. I am in excellent health, I workout with weights and also take various aerobic classes at the Y in town. On the weekends we walk 10 miles. So I feel that I am the poster-child for good health.

    Let me know what you think about this situation. I am going to wait until January 2011 before I make any decisions.
    bonebabe replied to Yoliz's response:
    What are your T-scores? Have you ever been on hormones, steroids or antiseizure meds? For you to have been on Forteo, your doctor must have felt you were at high risk for fracture.

    The fact that you haven't broken a bone is wonderful. You also exercise (although I'd be wary of the aerobic if your bone density is low) and take your calcium and Vit D. All excellent.

    Forteo builds new bone and it sounds like it did the job for you. Since the Actonel was ineffective you need something to strengthen that new bone. That's where the Prolia comes in.
    It is expensive, but is covered under your medical, not drug, insurance since it's given in a health care setting by a health care professional. If your portion is $150 a shot, I'd say that was pretty reasonable. I can tell you that the cost of having a hip or spinal fracture is much more than that and the life altering effects last a lifetime.
    osteogirl responded:
    I just finished my 2 years on forteo and get my first Prolia shot tomorrow. I tolerated Forteo very well with 40% bone growth. My doctor feels Prolia is the next step since the other osteo drugs did nothing for me. I will let you know if I experience any side effects. Hope, hope not!
    Yoliz replied to osteogirl's response:
    Greetings to you! I would be interested in hearing from you about your experience with Prolia. I too had a similar experience with other osteo drugs, so Forteo was my next option. I just completed - today - my last Forteo injection. I'm thinking about waiting until Jan to begin Prolia. Let me know what you think!!
    osteogirl replied to Yoliz's response:
    My doctor wanted a two week period between the end of my last Forteo shot and the first Prolia shot. The shot was given in the abdoman by my doctor...totally painless. It has been a week and no visable side effects. I get a blood test in a month from now and another one a month before my next shot (shots every 6 months). I keep you posted.
    proliaornot replied to osteogirl's response:
    How are you doing now? ?Sure would love to hear from womeone who has taken it. ?Considering prolia and scared.
    osteogirl replied to proliaornot's response:
    Two weeks since the Prolia shot and still feel fine. What have you taken thus far for osteoporosis? Any side effects?
    proliaornot replied to osteogirl's response:
    Took fosamax years ago, have bad GERD issues, cannot tolerate oral bisphosphomates. ?Hypothroid, hashimotos. Tried Forteo, bad reaction. ?-4.5, scared. ? 59. ?Tell me more about your situation. ?No reaction at all, that is wonderful. ?Would like to know more. ?Wish we could email. ?I am scared. ?
    osteogirl replied to proliaornot's response:
    I am 56, have had hypothroidism for 10 years, but not hashimotos. I have high blood pressure, high cholesterol, pre-diabetic, and oseoporosis....everything my mother had... and take medication for it all. I am 5'1" (and shrinking) and 115 lbs. I exercise 3-5 times at week at the gym and also walk and hike. I get regular bloodwork and try to stay on top of my health issues. In July, I had my gallbladder removed...polyps and stones. I now feel better than I have felt in years. Menopause is over as well. What was your bad reaction to Forteo? Have you looked into Reclast? I know, it has side effects too. Have you had any fractures or broken bones?
    proliaornot replied to osteogirl's response:
    No broken bones. ?Looking at Reclast. Scary. ?Dr. recommending reclast or prolia. ?Would like to consider forteo again, could have been a drug combination that caused issues. ?Don't know that would even be considered again. ?How did you feel on the forteo? ?What is your bone density now? ?When I took the forteo, my knees hurt so bad, I could hardly walk. ?Shin splints. ?I walk every day. ?About your size. ? I am glad you are doing well on the prolia. ?No side effects at all? ?Do you know anyone else on Prolia?
    proliaornot replied to osteogirl's response:
    Still feel fine.....after the prolia shot? ?An side effects at all? ?Thank you for answering. ?

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