If you have a risk of bone fractures, your doctor may suggest Prolia or Xgeva as a treatment option for you. These are prescription drugs that can help prevent bone fractures in people with certain cancers.
A key difference between Prolia and Xgeva is that each drug helps prevent bone fractures related to different kinds of cancer.
Prolia and Xgeva have other uses as well. To learn more, see “What are Prolia and Xgeva used for?” below.
Keep reading to learn more about how Prolia and Xgeva compare.
Note: For more information about these drugs, including details about their uses, see the in-depth articles on Prolia and Xgeva.
Prolia and Xgeva are used to treat and help prevent certain conditions.
See the table below to learn which conditions each drug treats or prevents.
| Condition treated or prevented | Prolia | Xgeva |
| bone fractures in people with prostate or breast cancer taking certain cancer treatments | ✓ | |
| bone fractures in people with bone cancer caused by solid tumors or in people with multiple myeloma | ✓ | |
| osteoporosis in certain situations | ✓ | |
| high calcium level in the blood caused by cancer that has not improved after taking a bisphosphonate drug | ✓ | |
| giant cell tumor (a type of bone tumor) that cannot be removed with surgery | ✓ |
To learn more about using Prolia or Xgeva to treat your condition, talk with your doctor.
Prolia or Xgeva and children
Xgeva may be used in certain children to treat giant cell tumors that cannot be removed with surgery. It’s used for this purpose in children whose bones have stopped growing. This usually happens around age 12 years.
Prolia is not approved for use in children.
Whether you have health insurance or not, cost may be a factor when you’re considering these drugs. Talk with your doctor, pharmacist, or insurance provider for more information.
Keep in mind that what you’ll pay for either drug will depend on your treatment plan and health insurance. It may also depend on the cost of your visit to a healthcare professional to receive doses of Prolia or Xgeva.
Prolia and Xgeva are both brand-name biologic drugs. A biologic is made from parts of living cells.
These medications do not have biosimilar forms. (Biosimilars are made for biologic drugs. They’re similar to generic drugs, which are made for nonbiologics.) You may pay more for brand-name drugs than for biologics.
For other resources that might help you save on the price of these drugs, see these articles on Prolia and Xgeva.
You may wonder if Prolia or Xgeva is available as a biosimilar.
Biosimilars are like generic drugs. But unlike generics, which are made for nonbiologic drugs, biosimilars are made for biologic drugs.
To find out if Prolia or Xgeva is available as a biosimilar, see the list below.
- Prolia:
- Available as a biosimilar: no
- Active ingredient*: denosumab
- Xgeva:
- Available as a biosimilar: no
- Active ingredient: denosumab
* An active ingredient is what makes a drug work.
Below is an overview of the dosage and how you’ll receive Prolia and Xgeva for the condition they both help prevent.
Prolia and Xgeva are also used to treat other conditions, but these aren’t addressed below. To learn more about the dosages for all conditions these drugs treat or prevent, see the dosage articles for Prolia and Xgeva.
Dosage for preventing bone fractures
Below are the dosages of Prolia and Xgeva when used to help prevent bone fractures. The strength of each drug is listed in milligrams per milliliter (mg/mL).
| Prolia for preventing bone fractures | Xgeva for preventing bone fractures | |
| Forms | liquid solution inside a prefilled syringe (see below) | liquid solution inside a single-dose vial (see below) |
| Strengths | 60 mg/mL | 120 mg/1.7 mL |
| Dose | 60 mg (one syringe) | 120 mg (one vial) |
| How often you’ll receive it | once every 6 months | once every 4 weeks |
Prolia and Xgeva are both given as an injection under the skin of your belly, thigh, or upper arm. You’ll receive injections of either drug in a doctor’s office or clinic.
You may have mild or serious side effects with Prolia and Xgeva. Below are details about some of the side effects each drug may cause.
For more information about possible side effects, see the side effect articles on Prolia and Xgeva.
Mild side effects
Prolia and Xgeva may cause mild side effects in some people. The table below lists examples of mild side effects that have been reported with these drugs.
| Prolia | Xgeva | |
| belly pain | ✓ | |
| mild pain in the arms, legs, back, muscles, or joints | ✓ | ✓ |
| skin rash | ✓ | ✓ |
| headache | ✓ | ✓ |
| bladder infection or urinary tract infection (UTI) | ✓ | |
| bronchitis | ✓ | |
| upper respiratory infections, such as the common cold | ✓ | ✓ |
| digestive problems, such as vomiting and constipation | ✓ | ✓ |
| loss of appetite | ✓ | |
| fatigue (low energy) | ✓ | |
| shortness of breath | ✓ | |
| low levels of red blood cells | ✓ | ✓ |
| low levels of platelets (cells that help form blood clots) | ✓ | |
| low levels of phosphate in the blood | ✓ |
This table may not include all mild side effects of these drugs. For more information on mild side effects of the two drugs, see the prescribing information for Prolia and Xgeva.
Serious side effects
In addition to the mild side effects described above, serious side effects may occur in people using Prolia or Xgeva. See the table below for a list of side effects that have been reported with these drugs.
| Prolia | Xgeva | |
| serious infections, such as pneumonia | ✓ | ✓ |
| skin problems, such as eczema or dermatitis | ✓ | |
| high blood pressure | ✓ | |
| high cholesterol | ✓ | |
| pancreatitis (swelling of the pancreas) | ✓ | |
| severely low blood calcium level | ✓ | ✓ |
| osteonecrosis of the jaw (death of jawbone tissue) | ✓ | ✓ |
| severe pain in the bones, muscles, or joints | ✓ | ✓ |
| thigh or spine fractures | ✓ | ✓ |
| problems making new bone tissue | ✓ | |
| allergic reaction* | ✓ | ✓ |
* An allergic reaction is possible after using either drug. This side effect wasn’t reported in studies of Prolia or Xgeva. But allergic reaction has been reported since both drugs became available for use.
Your doctor can tell you more about your risk of serious side effects with Prolia and Xgeva.
You may wonder whether Prolia and Xgeva are effective at preventing bone fractures related to certain cancers.
Studies have found Prolia to be effective in preventing bone fractures in people with prostate or breast cancer. Denosumab, the active ingredient* in Prolia, is recommended as a treatment option for this purpose. It’s recommended in the following guidelines from the National Comprehensive Cancer Network (NCCN):
- guidelines for advanced stage prostate cancer
- guidelines for invasive breast cancer
- guidelines for metastatic breast cancer
Studies have also found Xgeva to be effective for preventing bone fractures in people with bone cancer caused by solid tumors or in people with multiple myeloma. NCCN guidelines for multiple myeloma recommend denosumab (Xgeva’s active ingredient) for this use.
If you’d like to read more about how each drug performed in studies, see the prescribing information for Prolia and Xgeva.
* An active ingredient is what makes a drug work.
Prolia and Xgeva may not be right for you if you have certain medical conditions or other factors that affect your health. These may be referred to as warnings.
The two drugs share some of the same warnings, but they also have different ones. Some of these warnings are mentioned below. Before you start receiving Prolia or Xgeva, be sure to talk with your doctor to see if these warnings apply to you.
Before using Prolia or Xgeva, talk with your doctor if any of the following conditions or health factors apply to you.
- Warnings for Prolia:
- if you have any factors, such as certain thyroid problems, that affect how well your body absorbs minerals
- Warnings for Xgeva:
- if you have osteoporosis
- Warnings for both Prolia and Xgeva:
- if you’ve had an allergic reaction to either drug or any of its ingredients
- if you’re pregnant or planning to become pregnant
- if you’re breastfeeding or planning to breastfeed
- if you have a low blood calcium level
- if you have a kidney problem
- if you have a planned dental procedure, including dental surgery
To learn more about these drugs, see the in-depth articles on Prolia and Xgeva.
The short answer: No, it’s not likely.
Details: Prolia and Xgeva contain the same active ingredient,* denosumab. Both drugs are used to help prevent bone fractures in people with certain cancers. But each drug is used to prevent bone fractures related to different kinds of cancer.
Because Prolia and Xgeva are not used for the same cancers, your doctor isn’t likely to have you switch from one drug to the other.
Reminder: You should not switch drugs or stop your current treatment unless your doctor recommends it.
* An active ingredient is what makes a drug work.
If you have a risk for bone fractures, your doctor may recommend Prolia or Xgeva. They’re both used to help prevent bone fractures in people with certain cancers.
If you’re interested in learning more about Prolia or Xgeva, talk with your doctor. They can answer questions you may have to determine if one of these drugs is right for you. Below are a few example questions to get you started:
- Can Prolia or Xgeva cause long-term side effects?
- How do Prolia and Xgeva compare with other treatment options for my condition?
- Do I have any health factors that make Prolia or Xgeva a better treatment option?
To learn more about Prolia, see these articles:
- All About Prolia Injection
- Side Effects of Prolia: What You Need to Know
- All About Prolia’s Dosage
- Prolia and Cost: What You Need to Know
And for more information about Xgeva, see these articles:
To get information on different conditions and tips for improving your health, subscribe to any of Healthline’s newsletters. You may also want to check out the online communities at Bezzy. It’s a place where people with certain conditions can find support and connect with others.
Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.