Important Questions to Ask Before Starting Prolia (Denosumab) Treatment
Before starting Prolia (denosumab) treatment, you should ask your healthcare provider about preventive dental measures, monitoring for hypocalcemia, potential side effects, and what to do if you miss a dose or want to discontinue treatment. These questions are essential to ensure safe and effective treatment with this medication.
Medical History and Eligibility Questions
- What is my current bone mineral density (BMD) and fracture risk assessment (FRAX score)?
- Am I at high risk for fractures based on my T-score, previous fractures, or other risk factors?
- Have I failed or am I intolerant to other osteoporosis treatments?
- Do I have any kidney problems, especially advanced chronic kidney disease (eGFR < 30 mL/min/1.73 m²)? 1
- Should I have any laboratory tests before starting treatment (calcium levels, vitamin D levels, kidney function)?
- For patients with advanced kidney disease: Has my parathyroid hormone (iPTH), serum calcium, and vitamin D levels been checked? 1
Dental Health Considerations
- Do I need a dental examination before starting Prolia? 2
- What preventive dental measures should I complete before beginning treatment? 3
- What is my risk for osteonecrosis of the jaw, and how can I minimize this risk? 1
- Should I inform my dentist that I will be taking Prolia?
Treatment Administration and Schedule
- How is Prolia administered and how often will I need to receive it?
- Who will administer the injection and where will it be done?
- What should I do if I miss a scheduled dose? 1
- How long will I need to stay on Prolia treatment? 3
Potential Side Effects and Monitoring
- What are the most common side effects of Prolia? 1, 4
- How will you monitor me for hypocalcemia, especially since it can be severe? 1
- What symptoms of hypocalcemia should I watch for (muscle spasms, numbness, tingling)? 1
- What is my risk for skin reactions, and what symptoms should I report? 1, 4
- How will you monitor my bone density during treatment? 3
- Should I be concerned about unusual fractures (atypical femur fractures) while on this medication? 3, 1
Supplementation and Lifestyle Modifications
- Should I take calcium and vitamin D supplements while on Prolia? 3
- What dosage of calcium and vitamin D do you recommend? 3
- What lifestyle modifications should I make to support bone health (exercise, diet, smoking cessation)? 3
- Are there any foods or medications I should avoid while taking Prolia?
Special Considerations for Women
- If I am a woman of reproductive potential, what contraceptive measures should I use while on Prolia? 1
- What happens if I become pregnant while on Prolia? 1
- Is it safe to breastfeed while taking Prolia? 1
Treatment Discontinuation
- What happens if I need to stop taking Prolia? 3
- Is there a risk of rebound bone loss if I discontinue treatment? 3, 5
- Will I need to transition to another medication if I stop Prolia? 3
- What is the risk of multiple vertebral fractures after discontinuation? 5
Effectiveness and Alternatives
- How effective is Prolia compared to other osteoporosis treatments? 6, 5
- What are my alternative treatment options if Prolia is not suitable for me? 3
- How will we know if the treatment is working? 3
- How often will my bone density be measured to assess treatment effectiveness? 3
Insurance and Cost Considerations
- Is Prolia covered by my insurance?
- What will be my out-of-pocket cost for this medication?
- Are there any patient assistance programs available if I cannot afford this medication?
Remember that Prolia is administered as a subcutaneous injection every 6 months, which may improve treatment adherence compared to other osteoporosis treatments 6. However, it's critical to understand the potential risks, especially the need for dental evaluation before starting treatment and the risk of vertebral fractures if treatment is discontinued abruptly 5.