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If you are currently being treated for osteoporosis with Prolia, the February 2023 issue of the Journal of the American Board of Family Medicine contained a study that could cause your healthcare provider to recommend a change to your medication. This article is very complex and is aimed at a professional audience, so we have done an analysis so that we can help you to understand better what it means for you.

Before getting into the details, we can briefly summarize what the study set out to prove, and what the outcome is. 

The purpose

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Prolia particularly treats osteoporosis in people who have a high risk of developing sprains and fractures.

There are several different drug families designed to reduce fracture risk in patients with osteoporosis, but their costs vary widely, and so far, a systematic study on the comparative efficacy of these drugs hasn’t been done. 

Bisphosphonates have for decades been considered the standard of care. However, over the last ten years, Prolia (denosumab) has entered the market and is recommended by many doctors rather than bisphosphonates. The American College of Physicians in 2017 and the American Academy of Clinical Endocrinologists in 2016 consider bisphosphonates and denosumab to both be first-line agents for the treatment of osteoporosis.

Both types of treatment are long-going. Treatment with any of the bisphosphonates usually costs around $1000 per year. In the US, Prolia costs approximately $3000 per year. 

The purpose of this study was not to test whether either of the two possible treatments is superior to the other (comparing denosumab to bisphosphonates) but rather to evaluate the relative benefits based on cost – in other words, is denosumab worth the additional cost for reducing fractures in postmenopausal women with osteoporosis. 

The findings

The clinical findings in the reports analyzed came up with several relevant statistics. Denosumab was associated with a 3.7% reduction in clinical fractures compared with 2.6% for bisphosphonates. Denosumab was also associated with a 2.4% reduction in osteoporotic fractures compared with 1.7% for bisphosphonates. This shows that overall, Prolia gives additional positive results when compared to bisphosphonates.

The outcome

The report aimed to determine whether the price difference between denosumab and bisphosphonates is justified. For patients buying either Prolia or any of the bisphosphonates, the price difference is substantial (Prolia is about three times the annual cost), so there would have to be very significant improvements in the outcomes for any statistical study to determine that the price difference is justified.

In the end, this study found that although Prolia provides considerable advantages, its price difference can’t be justified. 

BUT, this is only the case when Prolia is being sourced from a US retail pharmacy. Here on, we have been supplying Prolia to hundreds of customers for many years, at the far more competitive price of $480 per 60 mg dose of Prolia. This brings the cost down from the very high level taken for comparison in the study ($3000 per year) to just $960. 

That makes the cost of Prolia to you almost exactly the same as the bisphosphonates, and you will still be getting the advantages, convenience and benefits of this ‘gold-standard’ medication.

While we do not mean to advise you to dispute a recommendation from your healthcare provider if you are recommended to switch from Prolia, we believe it is worthwhile knowing whether the advice is coming based on the article we have cited. In that case, you can suggest to the prescriber that the factor of cost could be set aside, since you have a source of Prolia at a fully competitive price.

More about osteoporosis

Osteoporosis is a bone disease that affects many menopausal women. It is a condition in which the bones become weak and brittle, making them more susceptible to fractures. According to the National Osteoporosis Foundation, about one in two women over the age of 50 will experience an osteoporosis-related fracture. We will discuss the main symptoms, causes, and treatments for osteoporosis in menopausal women.


Osteoporosis often goes undiagnosed until a fracture occurs. However, some early signs and symptoms of osteoporosis may include back pain, loss of height, and a stooped posture. According to a 2021 study by the Mayo Clinic, women with osteoporosis may also experience frequent fractures, particularly in the hip, spine, and wrist.


According to the Cleveland Clinic, the leading cause of osteoporosis in menopausal women is the decline in estrogen levels. Estrogen plays a significant role in maintaining bone density. As women age and approach menopause, their estrogen levels decline, leading to bone loss. Additionally, other factors such as a family history of osteoporosis, smoking, excessive alcohol consumption, and low calcium and vitamin D intake can increase the risk of developing osteoporosis.


The goal of treatment for osteoporosis is to prevent fractures and to maintain bone density. Treatments for osteoporosis in menopausal women may include medication, lifestyle changes, and dietary changes.

Medications that may be prescribed include monoclonal antibodies like Prolia or bisphosphonates (Actonel, Fosamax, Reclast, or Boniva), which work by slowing down the rate of bone loss. Hormone therapy may also be used, although it is not recommended for long-term use.

Lifestyle changes that can help improve bone health include regular exercise, particularly weight-bearing exercises such as walking and strength training. Quitting smoking and reducing alcohol consumption can also help prevent bone loss. Additionally, ensuring adequate calcium and vitamin D intake through diet or supplements is crucial for maintaining bone health.

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