Denosumab (XGEVA®, Prolia®)

Denosumab (XGEVA®, Prolia®) is used to strengthen and protect the bones from the effect of cancer or cancer treatment. It belongs to a group of targeted therapy drugs known as monoclonal antibodies.

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

XGEVA® and Prolia® are 2 different types of denosumab. They are given in slightly different ways. The one you have will depend on your situation.

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 cancer doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.

More information about this treatment

This information is correct at time of publishing. But sometimes the types of cancer this treatment is used for, or treatment side effects, may change between revision dates.

You can talk to your cancer team if you want more detailed information about this treatment. Or visit the electronic Medicines Compendium (eMC) website, which has patient information leaflets (PIL) for individual drugs.

How denosumab is given

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

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

You will have a blood test before each treatment to check the amount of calcium in your blood.

During a course of treatment you usually see a:

  • cancer doctor
  • chemotherapy nurse or specialist nurse
  • specialist pharmacist.

This is who we mean when we mention doctor, nurse or pharmacist in this information.

Your course of treatment

Your doctor, nurse or pharmacist 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 that are less common. 

You may get some of the side effects we mention, but you are unlikely to get all of them. And you may have some side effects, including rarer ones, that we have not listed here. 

Other cancer treatments may cause different side effects. If you are also having other cancer treatment, you may have other side effects.

Always tell your doctor, nurse or pharmacist about any side effects you have. They can give you: 

  • drugs to help control some side effects 
  • advice about managing side effects. 

It is important to take any drugs exactly as explained. This means they will be more likely to work for you.

Serious and life-threatening side effects

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

Contact the hospital

Your doctor, nurse or pharmacist will give you 24-hour contact numbers for the hospital. If you feel unwell or need advice, you can call at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

Common side effects

Low calcium in the blood

Your will have regular blood tests to check your calcium levels. If they are low, your doctor, nurse or pharmacist will prescribe calcium and vitamin D supplements for you.

Contact your cancer team or hospital straight away if you get any of these signs:

  • muscle spasms, twitching or cramps
  • tingling around your mouth or in your fingers and toes
  • drowsiness or confusion.

Bone and muscle pain

This treatment 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, nurse or pharmacist if this happens. They can give you painkillers to help.

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

Jaw problems (osteonecrosis)

Osteonecrosis of the jaw is when healthy bone tissue becomes damaged and dies.

The risk of getting osteonecrosis can increase due to:

  • gum disease
  • problems with dentures
  • some dental treatments.

Your doctor, nurse or pharmacist will advise you to have a full dental check-up before starting denosumab. It is important to them if you are having or plan to have dental treatment. 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. 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 team 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, nurse or pharmacist straight away.

Skin rashes

Prolia® can cause skin rashes. It is important to tell your doctor, nurse or pharmacist 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, nurse or pharmacist straight away.


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

If you are passing loose stools 3 or more times a day and this is not normal for you, contact the hospital as soon as possible on the 24-hour number. Follow the advice they give you about:

  • taking anti-diarrhoea medicines 
  • drinking enough fluids to keep you hydrated and to replace lost salts and minerals
  • any changes to your diet that might help. 

They might also ask you for a specimen of your stool to check for infection.


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 on the 24-hour number for advice. They can give you drugs called laxatives to help. 

If you have not been able to pass stools for over 2 days and are being sick, contact the 24-hour number straight away. 


XGEVA® may make you feel breathless. Always tell your doctor, nurse or pharmacist 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, nurse or pharmacist if these symptoms affect you. It may help to take mild painkillers.

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

Prolia® can cause back pain and sciatica. Tell your doctor, nurse or pharmacist if this happens. They can give you painkillers to help.

Contact your cancer team or the hospital straight away if you have:

  • numbness or tingling in your lower back or legs - this may be caused by pressure on nerves in or around the spine
  • weakness or loss of sensation in your legs
  • loss of bladder or bowel control.

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, nurse or pharmacist if you have any concerns.

Second cancer

In people with advanced cancer, Xgeva® is linked to a risk of developing another type of tumour. This could be non-cancerous or cancer. Your doctor, nurse or pharmacist can give you more information.


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

Less common side effects

Allergic reaction

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

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

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

Other information

Other medicines

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

Sorbitol (a type of sugar)

This treatment contains sorbitol. Tell your doctor, nurse or pharmacist if you think you have an intolerance to some sugars. They can advise you if denosumab is safe for you to take.


Doctors usually recommend that people with cancer have vaccinations for flu and for coronavirus (covid). These help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.

If your immune system is weak, you should not have live vaccinations. Live vaccines can make you unwell because they contain a very weak version of the illness they will protect you against. Live vaccines include Zostavax®, which is a shingles vaccine, and the yellow fever vaccine.

It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can explain what vaccines are right for you and when it is best to have them.


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.


Your doctor, nurse or pharmacist will advise you not to get pregnant or make someone pregnant while having this treatment and for some time afterwards. The drugs may harm a developing baby. It is important to use contraception to prevent pregnancy. Follow their advice about:

  • what types of contraception to use 
  • how long after treatment you should continue to use contraception. 


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

Your doctor, nurse or pharmacist can give you more information.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.

If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental 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.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

  • use plain English
  • explain medical words
  • use short sentences
  • use illustrations to explain text
  • structure the information clearly
  • make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.

Date reviewed

Reviewed: 01 November 2023
Next review: 01 November 2025
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

Our cancer information meets the PIF TICK quality mark.

This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.