From the Research
For patients on Prolia (denosumab) for osteoporosis, DEXA scans are typically recommended every 1-2 years, as supported by the most recent and highest quality study 1.
Key Considerations for DEXA Scan Frequency
- A baseline DEXA scan should be obtained before starting treatment to establish a reference point for future comparisons.
- A repeat scan is recommended after 1-2 years to assess the initial treatment response and adjust the treatment plan as necessary.
- For stable patients with a confirmed positive response to denosumab, subsequent DEXA scans can be spaced out to every 2 years.
- More frequent monitoring, such as annual DEXA scans, may be warranted for patients with multiple risk factors, those who have experienced fractures while on therapy, or when considering a drug holiday.
Importance of Monitoring with Prolia
The timing of DEXA scans is crucial for evaluating the effectiveness of Prolia, which works by inhibiting bone resorption through RANK ligand inhibition, resulting in increased bone mineral density.
- Monitoring is particularly important with Prolia because discontinuation without follow-up therapy can lead to rapid bone loss and increased fracture risk.
- Regular assessment of calcium and vitamin D levels is also necessary, as Prolia can cause hypocalcemia, especially in vitamin D-deficient patients.
Evidence-Based Recommendations
The most recent study 1 provides evidence that teriparatide should be used as the first-line perioperative treatment for patients with poor bone quality scheduled for posterior spine fusion, but for patients on denosumab, the recommended DEXA scan frequency remains every 1-2 years.
- This recommendation is based on the balance between monitoring the effectiveness of denosumab and minimizing the risks associated with over-monitoring or under-monitoring.
- The study 1 also highlights the importance of considering individual patient factors, such as risk factors and treatment response, when determining the optimal DEXA scan frequency.