Denosumab (Xgeva®, Prolia®)

Denosumab is a targeted therapy drug. It is used to treat secondary bone cancer. It is also used to help strengthen the bones for some types of cancer.

What is Denosumab (XGEVA®, Prolia®)?

Denosumab is a targeted therapy drug. It is used to treat secondary bone cancer. It is also used to help strengthen the bones for some types of cancer. Denosumab reduces bone pain and the risk of getting a broken bone (fracture).

It is best to read this information with our general information about the type of cancer you have. 

Denosumab belongs to a group of targeted therapy drugs known as monoclonal antibodies. 

There are two types of denosumab. The one you have will depend on your situation. Each has its own brand name:

  • XGEVA may be given to prevent bone problems, such as fractures, if you have cancer that has spread to the bones (secondary bone cancer). 
  • Prolia may be given if you have prostate cancer and have weakened bones due to hormonal therapy. You might also have it if you have breast cancer and have weakened bones after going through the menopause.

Your doctor will talk to you about this treatment and its possible side effects before you agree consent to having it.

How denosumab is given

You will have denosumab at the hospital as an outpatient. You have denosumab as an injection under the skin (subcutaneously). You have the injection in the thigh, stomach or upper arm. 

  • XGEVA is usually given once every 4 weeks.
  • Prolia is given once every 6 months.

Your doctor or nurse will take a blood test before each treatment to check the amount of calcium in your blood. 

During treatment you usually see a cancer doctor, a cancer nurse or specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.

Your course of treatment

Your nurse, pharmacist or doctor will discuss your treatment plan with you. They will explain how often you will have the injections.

About side effects

We explain the most common side effects of this treatment here. We also include some less common side effects.

You may get some of the side effects we mention, but you are unlikely to get all of them. If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.

Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.

Serious and life-threatening side effects

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.

Common side effects

Low calcium in the blood

A low level of calcium may cause muscle spasms, twitching, cramps, or tingling around your mouth or in your fingers and toes. Tell your doctor straight away if you get any of these signs. Your doctor will take regular blood tests to check your calcium levels. If they are low, they will prescribe calcium and vitamin D supplements for you. 

Occasionally, if calcium levels become very low, you may feel drowsy or confused. Let your doctor know if you, or other people, notice this.

Bone and muscle pain

Denosumab can cause pain in the bones and joints. This may be more common in your hands and feet. It can also cause some pain in the muscles. Tell your doctor if this happens. They can give you painkillers to help.

Jaw problems (osteonecrosis)

Osteonecrosis of the jaw is when healthy bone tissue becomes damaged and dies. Gum disease, problems with dentures, and some dental treatments can increase the risk of osteonecrosis.

Your doctor, nurse or pharmacist will advise you to have a full dental check-up before starting denosumab. If you have any mouth ulcers or sores, you should not start treatment until they have healed.

It is very important to look after your teeth during and after treatment with denosumab. Brush them regularly and have regular dental check-ups. It is important to tell your doctor or nurse if you are having any dental treatment. Let your dentist know you are having denosumab.

Some of the symptoms of osteonecrosis can include: 

  • pain and swelling in your jaw
  • redness of the gums or gum infections
  • loosening of teeth. 

Tell your cancer specialist and dentist straight away if you have any of these symptoms. Rarely, osteonecrosis can also affect the bones around the ears. If you have any ear pain, infection, or fluid leaking (discharge) from your ear, tell your doctor straight away.

Skin rashes

Denosumab (Prolia) can cause skin rashes. It is important to tell your doctor if this happens. They can give you medicine to help with this.

Occasionally this treatment can cause a skin infection. If you notice an area of skin becomes red, swollen and warm to touch, tell your doctor straight away.

Diarrhoea

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.

If you have diarrhoea:

  • try to drink at least 2 litres (3½ pints) of fluids each day
  • avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
  • contact the hospital for advice.

Constipation

This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:

  • Drink at least 2 litres (3½ pints) of fluids each day.
  • Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
  • Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.

Breathlessness

Denosumab (Xgeva) may make you feel breathless. Always tell your doctor if this happens or if you have any trouble with your breathing.

Flu-like symptoms

This treatment may cause flu-like symptoms such as:

  • feeling hot or cold or shivery
  • a headache 
  • muscle or body aches. 

Tell your doctor if these symptoms affect you. It may help to take mild painkillers.

Back pain, tingling or numbness down your leg (sciatica)

Denosumab (Prolia) can cause back pain and sciatica. Tell your doctor if this happens. They can give you painkillers to help. It is important to let your doctor know if you have any numbness or tingling in your lower back or legs. This may be caused by pressure on nerves in or around the spine.

Tell your doctor straight away if you have any weakness, loss of bladder or bowel control, or you feel any loss of sensation in your legs.

Eye changes

Denosumab (Prolia) can cause clouding of the eye’s lens (cataracts). Tell your doctor if you notice any changes in your vision. Do not drive if your vision has been affected.

Sweating more than usual

Some people may find that they sweat more than usual while having this treatment. Try to drink plenty of fluids if this happens. You can talk to your doctor if you have any concerns.

Second cancer

In people with advanced cancer there may be more risk of getting another type of tumour with Xgeva. This could be non-cancerous or cancer. Your doctor can give you more information.

Infections

You may have more urinary tract infections or chest infections with Prolia. Tell your doctor if you have any symptoms linked with infection.

Less common side effects

Allergic reaction

This is a rare side effect of denosumab. Signs of an allergic reaction can include:

  • itching
  • a rash
  • feeling short of breath
  • chest pain.

Tell your nurse or doctor straight away if you have any of these symptoms so that if you are having a reaction, it can be treated quickly.

Pain in the hip, groin or thigh

A rare side effect of denosumab is a fracture of the thigh bone (femur). Tell your doctor if you have any new or unusual pain in your hip, groin or thigh during or after treatment with denosumab.

Other information

Other medicines

Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:

  • medicines you have been prescribed
  • medicines you buy in a shop or chemist
  • vitamins, herbal drugs and complementary therapies.

Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.

You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.

Sorbitol (a type of sugar)

Denosumab contains sorbitol. Tell your doctor if you think you have an intolerance to some sugars. They can advise you if denosumab is safe for you to take.

Latex allergy

The needle cover of the prefilled Prolia syringe contains dry natural rubber, which may cause allergic reactions in people who are sensitive to latex. Tell your doctor if you have a latex allergy before you start treatment.

Vaccinations

Vaccinations can reduce your risk of getting certain infections. Your doctor or nurse may talk to you about having vaccinations.

Doctors usually recommend that people with cancer have a flu vaccination and a coronavirus vaccination. These are both inactivated vaccinations that can help reduce the risk of infection. People with weak immune systems can have these, as they are not live vaccinations.

If your immune system is weak, you need to avoid live vaccinations. This is because they can make you unwell. Live vaccines, such as shingles, contain a very weak version of the illness they are vaccinating you against. Your cancer doctor or GP can tell you more about live and inactivated vaccinations.

Fertility

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Contraception

Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.

Breastfeeding

You are advised not to breastfeed while having this treatment, or for some time after treatment finishes. This is because the drugs could be passed to the baby through breast milk.

Your doctor or nurse can give you more information.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.

About our information


  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert health professionals and people living with cancer.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.