Prolia® (generic name: denosumab) has become one of the most widely prescribed medications for treating osteoporosis, especially in postmenopausal women and older adults at high risk of fracture. But despite its popularity, many patients still have questions: What is Prolia? Is it a bisphosphonate? How long can I take it? And what happens if I stop?
This guide answers all your questions with up-to-date information in 2025 to help you make the most informed decision possible about Prolia for osteoporosis.
What Is Prolia?
- Prolia (denosumab) is a prescription injection used to treat osteoporosis in women after menopause and in men with high fracture risk.
- It’s not a bisphosphonate.
- Is Prolia a bisphosphonate? No—Prolia is a monoclonal antibody, not a bisphosphonate.
- It works by inhibiting RANKL, a protein that activates the cells (osteoclasts) that break down bone.
How Does Prolia Work?
- Prolia binds to and inhibits RANKL, preventing bone breakdown.
- It’s given as a subcutaneous injection (Prolia shot) once every 6 months.
- It helps maintain or increase bone mineral density (BMD) and reduces the risk of:
- Vertebral fractures
- Hip fractures
- Non-vertebral fractures
Most patients see a DEXA scan improvement in BMD within 12 months of starting Prolia.
How Long Can You Take Prolia?
- How long can Prolia be used? There is no strict limit, but long-term safety data exists for up to 10 years.
- Your doctor will typically reassess after 5–10 years depending on:
- Age
- Fracture history
- BMD progress on DEXA scans
- Risk of stopping (see below)
What Happens When You Stop Prolia?
Stopping Prolia suddenly is risky. Unlike bisphosphonates, its effects wear off quickly after the 6-month window.
After stopping Prolia:
- Bone loss accelerates rapidly
- Risk of multiple vertebral fractures increases
- You may lose years of bone density gains if not transitioned correctly
What to take after stopping Prolia:
- A bisphosphonate (like alendronate or zoledronic acid) is typically prescribed to "lock in" bone density gains
- Stopping Prolia after 5 years? Make a plan with your doctor for transitioning to another medication to prevent rebound bone loss
Important: DEXA scans at KALOS can help assess when to taper or transition off safely.
DEXA Scans and Prolia: Why Monitoring Is Essential
To measure the impact of Prolia injections, it’s recommended to get a DEXA scan:
- Before starting treatment
- Every 1-2 months during treatment
- After stopping to monitor for bone loss or rebound risk
A DEXA scan shows changes in:
- Bone Mineral Density (BMD)
- Fracture risk score
- Osteopenia or osteoporosis progression
Is Prolia Right for You?
Prolia may be right if:
- You’re postmenopausal with moderate to severe osteoporosis
- You can’t tolerate bisphosphonates or have kidney issues
- You’ve had a fracture and need strong anti-resorptive therapy
It may not be ideal if:
- You can’t commit to long-term therapy
- You’re at low fracture risk
- You don’t have a transition plan after stopping
How Long Can Prolia Be Delayed?
- The standard interval is every 6 months
- Delays beyond 7 months may increase risk of bone loss and fractures
- If delayed, your doctor may recommend an oral bisphosphonate to bridge the gap
Book Your DEXA Scan in San Francisco at KALOS Today
If you’re starting, continuing, or planning to stop Prolia for osteoporosis, the smartest step you can take is to track your bone health with a DEXA scan. At KALOS, we offer fast, accurate scans in San Francisco that help you and your physician make data-driven decisions.
Schedule your scan today at KALOS—your journey to stronger bones starts now.
