What Is The Use Of Denosumab And Other Useful Information

Half of all women over the age of 50 will have an osteoporosis-related fracture during their lifetime. The risk of bone loss and related complications increases with age, hormone changes during and after menopause, certain chronic diseases, bone cancers, and some medical treatments. If you have recently been diagnosed with osteoporosis or bone loss, or if you aren’t happy with how your current treatment plan is working, consider talking to your doctor about available versions of denosumab.


What Is Denosumab?

Denosumab has been in use for nearly a decade and has been proven in numerous studies to increase bone density in postmenopausal women. You may recognize it by the brand names Prolia or Xgeva. It is classified as a monoclonal antibody, and works by targeting and destroying the cells that deplete your bone during the natural skeletal regeneration processes. This can slow rates of bone loss and, in many cases, reverse them.


Side Effects

Denosumab has been shown to be safe and effective in most cases. However, just like with any medication, there are potential side effects. Some of these side effects are serious, so be sure to talk to your doctor about any symptoms or changes you may notice after receiving your first dose.

Some of the most common side effects of taking denosumab are bladder infections, high cholesterol, pain in the back, arms, or legs, or generalized muscle pain. These should be discussed with your doctor.

Other side effects can be more severe, and may include an increased risk of broken bones, especially after stopping treatment, serious allergic reactions, low blood calcium levels, serious and prolonged infections, and skin problems. Some patients may experience bone, joint or muscle pain that is severe. Any of these side effects should be discussed with your doctor immediately and possibly reported to the FDA.


Considerations Before and During Treatment

Because denosumab can lower calcium levels in the blood, it should not be used by people with naturally low calcium levels. Also, calcium and vitamin D supplements will most likely be prescribed by your doctor while you are taking it. These will help counteract calcium loss that commonly occurs with the medication. Make sure you talk to your doctor before starting treatment if you are concerned about your current blood calcium levels.

You may experience certain dental issues while taking denosumab. Make sure you tell your dentist you are taking it before you have any dental work performed.

Because of the way monoclonal antibodies allow bones to regrow, their interior structural integrity may become weakened. So, while these drugs often reduce the risk of a fracture occurring, those that do are often complicated and require extensive surgery to repair. Women who are, or may become, pregnant should not take denosumab because it can cause serious harm to an unborn fetus.


What Does Denosumab Treat?

Denosumab is used to stop, and potentially reverse, bone loss in some postmenopausal women who are at increased risk of bone fractures, or who have not been able to treat their osteoporosis successfully with other medications, such as bisphosphonates, and lifestyle changes.

It may be used to increase bone density that results from certain cancer treatments in both men and women, and also to help repair damage from skeletal related events caused by cancers or tumors of the bone.


How Does It Work?

The human skeleton undergoes constant renewal throughout its lifetime. As people age, bone is often lost faster than it can be replaced naturally. Denosumab is a monoclonal antibody. It helps stop the bone loss that occurs naturally in the human body by destroying the cells responsible for it. Bones are then able to replace portions that have deteriorated.

Because the natural processes of loss and replacement occur on the outside of most bones, medically altering it can affect the structural integrity of certain bones. This is especially common in leg, spine, and hip bones as their weakened interior becomes covered with a renewed, strong exterior casing. This can cause unpredictable and complex fractures when they do occur.


How to Administer Denosumab

Both brands of the drug that are currently on the market, Prolia and Xgeva, are administered by subcutaneous injection. There are no available pill versions of the drug. These injections will be given in the upper arm, upper thigh, or abdomen.

You have two options for receiving your scheduled injections of Prolia: self-administration at home, or having the injection given by a healthcare provider in office. Injections must be administered every six months. Xgeva is given on a 4-week schedule, and must be administered in office by a healthcare professional. Treatments for both forms of denosumab must be given on schedule, as there are increased risks of fractures after stopping them.


Self-Administering a Prolia (Denosumab) Injection

Not everyone will be comfortable giving themselves an injection every six months. However, for those who are willing to learn the technique, at home injections can save time, expense, and the inconvenience that a trip to the doctor can bring.

The first step in giving yourself a Prolia (denosumab) injection is to check the syringe and its contents. Look carefully at the syringe. If you see any cracks or holes, or if the contents appear cloudy or contaminated, discard the dose in an approved container and notify your doctor. It is also a good idea to check the expiration date on your syringe at this time, and discard any medications past their printed expiration. Remember that maintaining your dosage schedule is very important, so don’t put off calling for another dose.

Assuming that the syringe is intact and the medication looks normal, remove it from the refrigerator about 30 minutes before you plan to give the injection. Allowing it to warm up a little, to about room temperature, will make the actual injection slightly more comfortable.

Injections can be given in the upper arm, upper thigh, or abdomen. Chose your injection location and sterilize the site with an alcohol swab. Make sure you thoroughly wash your hands with soap and warm water as well.

Hold the syringe pointed up and uncap the needle, then pinch the skin around the injection site. This allows you to administer the medication under the skin more effectively.

Insert the needle fully into the pinched fold of skin and push the plunger down until you hear it snap into place. Maintain the hold on the skin area until the needle is fully withdrawn from the injection site, then release the skin fold. Once you have administered the injection, make sure you dispose of the used syringe in an appropriate container.


In-Office Injections

If you are not ready to give yourself injections at home, or if you have been prescribed Xgeva, you can opt to receive them at your doctor’s office. This requires a trip to your healthcare provider’s office location, time waiting to see them, and the cost of your office visit. Since injections are scheduled for once every 4 weeks to six months, this could be a good time to check in with your doctor, have blood levels tested, report any side effects, and express any concerns about your health or treatment. Keeping an open line of communication with your healthcare provider is an invaluable tool in your treatment plan.


Conclusion

Denosumab is an injectable medication that targets bone-destroying cells. These cells are part of the natural bone renewal process that occurs throughout life, but that can lead to bone loss with age, injury, or certain medical conditions. Unlike other treatments for bone loss, denosumab has been shown to increase bone density in patients. In other words, it actually helps to regrow bone that has been lost to osteoporosis or other diseases.

You will likely see denosumab marketed under the brand names Prolia or Xgeva. Prolia is designed primarily for osteoporosis patients, and is available in convenient self-injectable syringes. Xgeva is generally used in patients undergoing cancer treatments, or with skeletal fractures related to bone tumors. Both drugs are sometimes prescribed for off-label use, so check which one is a better fit for your particular situation.

Regardless of the brand, denosumab is designed for use by a very specific group of people and may not be the best treatment option for your particular case. Make sure you talk to your healthcare provider about the possible benefits, risks, side effects, and long-term consequences of taking a denosumab-based drug.

If you decide it is an appropriate part of our treatment plan, take precautions and be alert for some of the most common side effects. These usually follow a predictable pattern, so ask your doctor what to expect and if you can help counteract them by taking calcium or vitamin D supplements.

Some interactions and negative effects from taking denosumab can potentially be reduced or avoided with careful planning between you and your healthcare provider. Make sure you have all the information you need and be honest and up front about any other medical conditions you may have. Keep in mind, also, that a comprehensive treatment plan for osteoporosis or other causes of bone loss includes much more than a single prescription. Talk to your healthcare provider about making changes to your diet and activity levels that could complement your new medication.