Actonel vs Prolia

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For patients with osteoporosis or other types of bone health concerns, certain drugs that alter the rate of bone formation and breakdown can help in maintaining bone density and preventing fractures. Actonel and Prolia are two such medications that are prescribed for these conditions. They each impact different pathways in the body related to bone metabolism but both have effects in preserving bone mass in patients with osteoporosis. Actonel is a type of drug called bisphosphonate, which works by reducing the activity of cells that cause loss of bone mass (osteoclasts). On the other hand, Prolia is classified as a RANK ligand inhibitor; it blocks a protein known as RANKL which plays an essential role in triggering increased activity of osteoclasts, resulting primarily in decreased loss of existing bones.

What is Actonel?

Risedronate (the generic name for Actonel) is a type of drug called a bisphosphonate, which was one of the first classes of medication developed to treat osteoporosis. Approved by the FDA in 2000, Actonel works by inhibiting bone resorption – it reduces how quickly your body removes old bone tissue, ensuring that new bone can be created faster than it's broken down. This leads to an overall increase in bone density and strength. On the other hand, Denosumab (marketed as Prolia) represents a different class of drugs known as monoclonal antibodies. It received FDA approval in 2010 and works differently from bisphosphonates like Risedronate; instead of slowing down the process of bone breakdown, Denosumab blocks a specific signal that causes cells to break down bones. Both medications are used primarily for treating osteoporosis but their distinct mechanisms mean they may have different side effects and could be more effective depending on individual patient factors.

What conditions is Actonel approved to treat?

Actonel and Prolia are specifically approved for the treatment of various bone-related conditions:

  • Postmenopausal osteoporosis, a condition that weakens bones making them fragile and more likely to break
  • Osteoporosis in men
  • Steroid-induced osteoporosis (Actonel only)
  • Treatment to increase bone mass in men at high risk for fracture receiving ongoing systemic glucocorticoid therapy (Prolia only)
  • Treatment of glucocorticoid-induced osteoporosis (Prolia only)

How does Actonel help with these illnesses?

Actonel works to manage osteoporosis by slowing down the process of bone thinning and loss. It does this by inhibiting the action of osteoclasts, cells that break down bone tissue, allowing for a greater balance between bone formation and breakdown. Bone is a living tissue that continuously undergoes remodeling, with old bone being removed and replaced by new. As we age or due to certain medical conditions, this balance can be disrupted leading to decreased bone density and increased risk of fractures. By suppressing the activity of osteoclasts, Actonel helps in maintaining stronger bones for longer periods of time.

On the other hand, Prolia takes an alternate approach towards managing osteoporosis. It's a monoclonal antibody designed to target RANKL (Receptor Activator for Nuclear Factor κ B Ligand), a protein essential for the formation, function and survival of osteoclasts. By binding to RANKL, Prolia prevents it from interacting with its receptor on the surface of osteoclast progenitor cells and mature osteoclasts thereby inhibits their formation resulting in reduced bone resorption which makes bones less likely to fracture.

Although both treatments aim at reducing risks associated with low-density bones such as fractures they have different mechanisms in achieving this goal.

What is Prolia?

Prolia, with its generic name denosumab, acts as a RANK ligand inhibitor. This means it inhibits the development and activity of osteoclasts (cells that break down bone) by blocking the action of another molecule called RANKL. The FDA first approved Prolia in 2010 for the treatment of postmenopausal women who are at high risk for osteoporotic fractures. Unlike bisphosphonates such as Actonel, which is absorbed into bone and works directly on osteoclasts to inhibit their activity, Prolia circulates in the bloodstream where it intercepts and neutralizes RANKL before it can reach its receptor on osteoclast progenitor cells. By doing so, Prolia prevents these cells from developing into mature bone-resorbing osteoclasts. This unique mechanism provides an alternative option for patients who cannot tolerate or do not respond well to traditional bisphosphonate drugs like Actonel.

What conditions is Prolia approved to treat?

Prolia is a medication that has been approved by the FDA for use in specific conditions. These include:

  • Osteoporosis in postmenopausal women at high risk of fractures
  • Bone loss in men undergoing androgen deprivation therapy for non-metastatic prostate cancer
  • Bone loss in women receiving adjuvant aromatase inhibitor therapy for breast cancer

How does Prolia help with these illnesses?

Prolia, like Actonel, is a medication used to treat and prevent osteoporosis. It works by affecting the RANKL protein, which plays a crucial role in bone remodeling – the ongoing process of bone tissue renewal. Prolia binds to this protein and inhibits its function, thereby reducing the formation and activity of cells that break down bones (osteoclasts). This results in decreased bone resorption and increased bone mass and strength. As it operates differently than bisphosphonates such as Actonel (which work by directly inhibiting osteoclasts), Prolia might be an effective alternative for patients who don't respond well to or can't tolerate other osteoporosis medications. Also, unlike daily or weekly oral tablets like Actonel, Prolia is administered via injection every six months.

How effective are both Actonel and Prolia?

Both risedronate (Actonel) and denosumab (Prolia) have established histories of success in treating patients with osteoporosis, and they were initially approved by the FDA only 10 years apart. Since they act on different mechanisms involved in bone remodeling, they may be prescribed under different circumstances. The effectiveness of risedronate and denosumab in alleviating symptoms of osteoporosis was directly studied in a double-blind clinical trial in 2014; the two drugs exhibited similar efficacy in managing symptoms as well as similar safety profiles.

A review published in 2008 demonstrated that risedronate is effective at reducing vertebral fractures starting from the first year of treatment, that its side effect profile is favorable over other many bisphosphonates, and it is well-tolerated even among elderly populations. Furthermore, it has become one of the most widely prescribed drugs for osteoporosis treatment globally. It also appears to reduce non-vertebral fractures effectively.

A meta-analysis carried out in 2017 indicated that Prolia seems to be more potent than placebo or any other common antiresorptive agents used for treating postmenopausal women with osteoporosis at high risk for fracture. However, Prolia generally serves as a second-line treatment option where bisphosphonates are contraindicated or not tolerated due to its higher cost compared to generic alternatives such as Actonel. Nonetheless, due to its unique mechanism targeting RANKL protein essential for formation and function of osteoclasts responsible for bone resorption, Prolia may be an optimal choice for patients who did not respond well or suffer adverse effects from bisphosphonates.

abstract image of a researcher studying a bottle of drug.

At what dose is Actonel typically prescribed?

Dosages of Actonel typically range from 5-35 mg/day, depending on the specific condition being treated. For most osteoporosis patients, a common dosage is 5 mg daily or 35 mg once weekly. Prolia, on the other hand, is administered as an injection twice per year with each dose containing 60mg. It's crucial to note that these dosages are general guidelines and individual treatment plans may vary based on patient-specific factors such as age, overall health status and concurrent medications. In any case, exceeding recommended doses without medical guidance should be avoided for both Actonel and Prolia due to potential side effects and complications.

At what dose is Prolia typically prescribed?

Prolia treatment is typically administered as a 60 mg injection, given once every six months by your healthcare provider. It's important that the duration between injections does not exceed six months to ensure continuous therapeutic effect. This medication should be used in conjunction with adequate amounts of calcium and vitamin D intake as directed by your doctor. If there seems to be no improvement or if the condition worsens after a few rounds of treatment, it would be necessary to consult with your healthcare provider for further evaluation and possible adjustment of treatment strategies.

What are the most common side effects for Actonel?

Common side effects seen with Actonel include:

  • Joint pain
  • Diarrhea or constipation
  • Stomach upset and indigestion
  • Back pain, bone pain or muscle aches
  • Flu-like symptoms (fever, chills, tiredness)
  • Headache

On the other hand, Prolia may cause:

  • Back pain
  • Pain in your arms and legs
  • High cholesterol levels
  • Muscle or joint discomfort
  • Bladder infection (like burning urine or frequent urination)

It is important to note that while these medications have various side effects, they do not typically cause anxiety, nervousness, insomnia etc. as mentioned above for Prozac and Wellbutrin. Please consult with your healthcare provider before starting any new medication treatment plan. In case you experience severe side effects from either of these drugs such as jaw numbness/pain/swelling/loosening of a tooth; unusual hip/thigh/groin pain; new/unusual thigh/hip/groin fractures seek immediate medical attention.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Actonel?

Prolia, like Actonel, is used to treat or prevent osteoporosis. However, it has its own set of potential side effects that you should watch for:

  • Signs of an allergic reaction: hives; difficult breathing; swelling in your face or throat.
  • Low calcium levels - muscle spasms or contractions, numbness or tingly feeling (around your mouth, fingertips, feet), tight muscles in your face, seizure (convulsions), and overactive reflexes.
  • Serious infections - fever, chills, skin sores/skin rash with blistering and peeling red/purple spots on the skin (not related to herpes zoster), increased urination or thirst/loss of appetite/vomiting/constipation/fruity breath odor/drowsiness/light-headedness
  • Skin problems - dry/reddish skin/swelling/blisters/oozing/wounds that won't heal
  • Unusual thigh bone fractures - new/unusual pain in hip/groin/thigh Severe jawbone problems – severe pain in the mouth/jaw/chewing difficulties/or swelling/infection around a dental work

If you experience any of these symptoms after taking Prolia immediately seek medical help.

What are the most common side effects for Prolia?

Common side effects of Prolia can include:

  • Back pain, muscle or joint discomfort
  • High cholesterol levels
  • Pain in the extremities (arms and legs)
  • Muscle weakness or spasms
  • Constipation, abdominal pain
  • Skin conditions such as rash or eczema
  • Bladder infection (urinary tract infection) In rare cases, serious side effects like low blood calcium levels and severe jaw bone problems may occur. It's important to contact your healthcare provider if you experience any unusual symptoms while taking Prolia.

Are there any potential serious side effects for Prolia?

Prolia, like any other medication, may cause side effects in some individuals. The following are warning signs that you might be experiencing a serious reaction to Prolia:

  • Skin issues such as rashes, hives or severe skin reactions which can include blistering and peeling
  • Swelling of the face, throat or tongue
  • Shortness of breath or trouble breathing
  • Osteonecrosis (bone death) in the jaw: symptoms can include jaw pain or swelling, loose teeth, gum infection, or slow healing after dental work.
  • Atypical fractures in the thigh bone: reported as dull aching pain starting weeks to months before a complete fracture occurs.

If you experience any of these side effects while taking Prolia, contact your healthcare provider immediately.

Contraindications for Actonel and Prolia?

Both Actonel and Prolia, along with most other osteoporosis medications, may worsen bone pain in some individuals. If you notice your bone pain worsening or an increase in fracture incidence, please seek immediate medical attention.

Neither Actonel nor Prolia should be taken if you are taking, or have recently taken bisphosphonates. Always inform your physician about which medications you are currently on; bisphosphonates will require a period of at least 12 weeks to clear from the system to prevent dangerous interactions with Actonel and Prolia.

It's also important to note that both these drugs can lead to serious side effects such as jawbone problems (osteonecrosis) especially after dental procedures like tooth extraction. Therefore, it is recommended to undergo any necessary dental work prior to starting treatment.

How much do Actonel and Prolia cost?

For the brand-name versions of these osteoporosis medications:

  • The price for a pack of 1-month supply (4 tablets) of Actonel (35 mg) averages around $130, which works out to approximately $32.50 per week as it is taken once weekly.
  • The cost for one dose of Prolia (60mg/1ml), which lasts six months, is about $1100. This equates to roughly $183 per month or about $42 per week.

Thus, if we compare on a weekly basis, brand-name Prolia is more expensive than Actonel. However, bear in mind that costs should not be your sole consideration when choosing between these two drugs; effectiveness and side effects are also very important considerations.

As an additional note:

  • There's no available generic version for Prolia.
  • Risedronate sodium is the less costly generic alternative to Actonel and can range from about $10-$20 for a monthly supply depending on insurance and location.

Popularity of Actonel and Prolia

Risedronate, in generic form as well as brand names such as Actonel, was estimated to have been prescribed to about 1.3 million people in the US in 2020. Risedronate accounted for just over 7% of prescriptions for osteoporosis drugs in the US. It seems to be a popular choice among bisphosphonates—a class of drugs that slow bone loss and increase bone density.

Denosumab, marketed under the brand name Prolia, was prescribed to approximately 2 million people in the USA during the same year. In terms of overall osteoporosis drug prescriptions in America, denosumab accounts for nearly 11%. The prescription rate of this monoclonal antibody—designed specifically to target proteins involved with bone breakdown—has seen steady growth since its approval by FDA back in 2010.


Both Actonel (risedronate) and Prolia (denosumab) have long-standing records of usage in patients with osteoporosis, and are backed by numerous clinical studies indicating they can effectively reduce the risk of fractures. Each drug carries its own unique mechanism of action: Actonel works by slowing down bone loss while increasing bone mass, whereas Prolia functions as a monoclonal antibody that inhibits a protein involved in bone breakdown.

Actonel is often considered a first-line treatment option for postmenopausal women at high risk for fracture. In contrast, Prolia is typically used as an alternative therapy for those who cannot take or do not respond to other medications such as bisphosphonates like Actonel.

Both drugs are available through prescription only. While there's no generic form of Prolia yet, generic versions of Actonel represent significant cost savings especially for patients paying out-of-pocket.

The side effect profile varies between the two drugs; both generally well-tolerated but carry risks common to many osteoporosis treatments including joint pain and back pain. In rare cases, both may cause more serious side effects like unusual thigh bone fractures or jawbone problems known as ONJ (osteonecrosis). For individuals on either medication, it's crucial to maintain regular check-ups with healthcare providers to monitor progress and any potential adverse reactions.