Evenity (romosozumab-aqqg) and Prolia (denosumab) are brand-name prescription medications. They’re approved by the Food and Drug Administration (FDA) to treat osteoporosis in certain people. Specifically, both drugs are used to treat osteoporosis in females who have gone through menopause and have a high risk of broken bones.

This article reviews the key similarities and biggest differences between Evenity and Prolia. If you’re considering treatment with one of these medications, talk with your doctor. By reviewing the risks and benefits, you can help decide whether either medication is right for you.

For more comprehensive information about these two drugs, you can refer to our Evenity and Prolia articles.

Note: Sex and gender exist on spectrums. Use of the terms “female” and “male” throughout this article refers to sex assigned at birth.

Key differences between Evenity and Prolia

These are a few of the main differences between Evenity and Prolia:

  • Dosage: Evenity is administered more often than Prolia. In addition, it isn’t recommended that Evenity be given for longer than 12 months. (See “Dosages, forms, and administration” below.)
  • Conditions treated: Evenity and Prolia are both used to treat osteoporosis in postmenopausal females at high risk of bone fractures. However, Prolia is also used for other purposes. (See “Uses of Evenity vs. Prolia” below.)
  • Side effects. Certain serious heart-related side effects, including heart attack, have been reported with Evenity but not Prolia. On the other hand, severe pain has occurred with Prolia but not Evenity.

Below are answers to some common questions about Evenity and Prolia.

How will my doctor determine whether Evenity or Prolia is better for me?

Your doctor will see whether you’ve tried osteoporosis treatments in the past and had any side effects. They’ll also review the rest of your health history and assess your needs.

Evenity is meant to be used in females for whom other osteoporosis treatments didn’t work or caused bothersome side effects. This is why your doctor may recommend trying Prolia before Evenity. However, they’ll prescribe a treatment based on your specific medical history and requirements.

Your doctor can tell you more about how they’ll determine the right treatment for you.

Is Evenity safer than Prolia?

It depends. Some medications may be safer for some people, but not others. Whether Evenity is safer than Prolia for you can depend on various factors. These can include your medication history and the osteoporosis treatment goals you set with your doctor.

To see a list of side effects these medications may cause, see “Side effects of Evenity vs. Prolia” below.

You can also talk with your doctor or pharmacist about the safety of Evenity and Prolia.

What is a good substitute for Prolia or Evenity?

If you’re wondering about other osteoporosis treatments, you can refer to these lists of alternatives for Evenity and Prolia. You can also talk with your doctor.

Keep in mind that certain medications may be more suitable for you than others. By reviewing the options with your doctor, together you can come up with the right treatment plan.

Can Evenity or Prolia affect the eyes?

No, eye-related side effects aren’t expected with either drug. Such side effects weren’t reported in clinical studies of Evenity or Prolia.

Other osteoporosis medications, called bisphosphonates, can cause eye-related side effects. These side effects include eye inflammation. Examples of bisphosphonate drugs are Fosamax (alendronate) and Actonel (risedronate).

That said, in rare cases, stroke* has been reported in people using Evenity. And stroke symptoms can include vision changes, along with numbness or weakness and difficulty talking. If you think you’re having symptoms of a stroke during Evenity treatment, immediately call 911 or your local emergency number.

If you have additional questions, talk with your doctor.

* Evenity has a boxed warning for this side effect. A boxed warning is a serious warning from the Food and Drug Administration (FDA). To learn more, see “Precautions of Evenity and Prolia” below.

How much Evenity or Prolia costs depends on the treatment plan your doctor prescribes, your insurance plan, and your pharmacy. It will also depend on the cost of the visit to a healthcare professional to receive doses of Evenity or Prolia.

Both Evenity and Prolia are available only as brand-name drugs. They’re not available in a biosimilar form. A biosimilar drugis similar to a brand-name biologic drug (also called the parent drug).

Biologic drugs are made from living cells. It’s not possible to make an exact copy of these drugs. A generic, on the other hand, refers to drugs made from chemicals. A generic is an exact copy of the active drug in a brand-name medication.

Biosimilars are considered to be as safe and effective as their parent medication. And biosimilars tend to cost less than brand-name medications.

For more information about the price of these medications, you can see our articles about Evenity and Prolia.

Evenity and Prolia are used to treat osteoporosis in females who have gone through menopause and are at high risk of bone fractures. These drugs can cause some of the same side effects, as well as some different ones. Some of the side effects reported for these drugs are mentioned below.

For more information about side effects of both drugs, see these articles about Evenity and Prolia. You can also refer to the Evenity prescribing information and Prolia prescribing information.

Mild side effects

The following table lists some of the more commonly reported mild side effects of Evenity and Prolia. The table may also include less common mild side effects that you might have concerns about in some cases.

Mild side effectsEvenityProlia
joint painxx
headachexx
swelling or fluid retentionxx
muscle spasmsx
feelings of burning, tingling, or “pins and needles”x
pain in your back, arms, or legsx
neck painx
high cholesterol levelx
mild urinary tract infection (UTI)x
common coldx
mild allergic reactionxx

These side effects may be temporary, lasting a few days to weeks. If the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

Serious side effects

The following table lists reported serious side effects of Evenity and Prolia.

Serious side effectsEvenityProlia
increased risk of serious cardiovascular problems, including stroke and heart attack*x
unusual fractures in your thigh bonexx
osteonecrosis (bone tissue death) in your jawxx
low blood calcium levelxx
broken bones in your spine after stopping treatmentx
serious infection, such as severe UTIx
severe pain in your bones, muscles, or jointsx
decreased bone production (bones taking longer than usual to make new tissue)x
severe allergic reactionxx

If you have serious side effects while using Evenity or Prolia, call your doctor immediately. If the side effects feel life threatening or you believe you’re having a medical emergency, call 911 or your local emergency number right away.

* Evenity has a boxed warning for this side effect. A boxed warning is a serious warning from the Food and Drug Administration (FDA). To learn more, see “Precautions of Evenity and Prolia” below.

Evenity and Prolia are approved to treat osteoporosis in females who have gone through menopause and have a high risk of broken bones. Here’s a quick look at the dosage and administration of the drugs for this purpose. In the table below, milligrams and milliliters are abbreviated as mg and mL.

Dosage for osteoporosis in certain females who have gone through menopause

Evenity for this useProlia for this use
Formsolution in a prefilled syringe for subcutaneous injectionsolution inside a prefilled syringe for subcutaneous injection
Strength105 mg per 1.17 mL solution60 mg per 1 mL solution
Dose210 mg (two injections at once)60 mg (one injection)
Frequencyonce per month for no more than 12 monthsonce every 6 months
Given byhealthcare professional (see below)healthcare professional (see below)

A healthcare professional, such as your doctor or pharmacist, will administer Evenity or Prolia doses by subcutaneous injection. You’ll need to go somewhere such as your doctor’s office or a pharmacy to receive your doses. They’ll give you the dose under the skin of your abdomen, thigh, or upper arm.

Note: For more information about dosage, you can refer to these articles about Evenity and Prolia.

Here’s information about the generic and biosimilar status for Evenity and Prolia, as well as their active ingredients.

EvenityProlia
Biosimilar availablenono
Active ingredientromosozumab-aqqgdenosumab
Drug classsclerostin blockerRANK ligand (RANKL) blocker

A biosimilar drug is similar to a brand-name biologic drug (also called the parent drug).

Biologic drugs are made from living cells. It’s not possible to make an exact copy of these drugs. A generic, on the other hand, refers to drugs made from chemicals. A generic is an exact copy of the active drug in a brand-name medication.

Biosimilars are considered to be as safe and effective as their parent medication. And biosimilars tend to cost less than brand-name medications.

Evenity and Prolia have been approved by the Food and Drug Administration (FDA) to treat the following.

  • Both Evenity and Prolia are FDA-approved to treat:
  • Prolia is also FDA-approved for use in the following people at high risk of bone fractures:
    • males with osteoporosis
    • males with prostate cancer that isn’t metastatic (spread to other areas of the body) and are taking certain medications to treat the cancer

Note: For more information about the drugs’ uses, see our articles about Evenity and Prolia.

You may be wondering how the effectiveness of Evenity and Prolia compare. Both drugs are approved to treat osteoporosis in females who have gone through menopause and are at high risk of broken bones.

Prescribing information. Here’s a brief look at how effective Evenity and Prolia were in clinical trials.

The trials for Evenity and Prolia found that the drugs decreased the risk of bone fractures in people given either medication. This was compared with people who received a placebo (treatment with no active drug).

For details about how these drugs performed in clinical trials, see the prescribing information for Evenity and Prolia. Keep in mind that trial results may not apply to your individual health situation.

Treatment guidelines. Another way to determine whether a drug is considered effective is to look at treatment guidelines.

When an organization includes certain drugs in treatment guidelines, this means that research has shown the drug to be safe and effective. Evenity and Prolia are included in guidelines from the Endocrine Society. The guidelines recommend either drug as a treatment option for certain females who have gone through menopause and are at high risk of bone fractures.

Evenity and Prolia may not be right for you if you have certain medical conditions or other factors that affect your health. The two drugs share some of the same precautions, but they also have different ones. Some of these precautions are mentioned below.

Boxed warning: Risk of stroke, heart attack, and death from cardiovascular problems

Evenity has a boxed warning for the risk of stroke, heart attack, and death from such cardiovascular problems. (Cardiovascular refers to the heart and blood vessels.) A boxed warning is a serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

Using Evenity may increase the risk of stroke, heart attack, and, in rare cases, death from such cardiovascular problems. Because of this risk, doctors typically won’t prescribe the drug if you’ve had a stroke or heart attack within the past year.

Before starting treatment with Evenity, your doctor should review your risks for cardiovascular problems. These may include high blood pressure or a history of stroke, heart attack, or heart failure. They’ll prescribe Evenity only if they believe the benefits outweigh the risks. They’ll also monitor you closely for symptoms of cardiovascular problems during your treatment.

If you have any questions about this warning, talk with your doctor.

Precautions

In addition to Evenity’s boxed warning, Evenity and Prolia have other precautions.

If any of the following medical conditions or other health factors are relevant to you, talk with your doctor before using Evenity or Prolia.

PrecautionEvenityProlia
if you’ve had an allergic reaction to either drug or any of its ingredientsxx
if you’re pregnant or thinking about becoming pregnantxx
if you’re breastfeeding or thinking about breastfeedingxx
if you have low blood calcium levelsxx
if you have dental problems or upcoming dental workxx
if you have kidney problemsxx
if you’re immunosuppressed (have a weakened immune system) x
if you have malabsorption syndrome (trouble absorbing minerals)x
if you have had surgery on your thyroid or parathyroid glandx

Note: For more comprehensive information about these two drugs, you can refer to our Evenity and Prolia articles.

Switching between Evenity and Prolia might be possible.

Your doctor may also switch you to Prolia once you complete 12 months of treatment with Evenity. (Evenity is prescribed for up to 12 months. For more information, refer to this article on its uses.) However, your doctor could recommend a different treatment for your osteoporosis instead.

If you’d like to know more about switching between Evenity and Prolia, talk with your doctor. They can give you additional details and help determine the best course of action for your situation. Even if two drugs treat the same condition or are in the same drug class, your body can still respond differently. It’s important that you do not stop, start, or switch any of your drug treatments without your doctor’s recommendation.

Evenity and Prolia are similar drugs that have some differences, too.

Some key points to remember when comparing Evenity and Prolia include:

  • Certain serious heart-related side effects, such as heart attack, have been reported with Evenity,* but not Prolia. On the other hand, severe pain has occurred with Prolia but not Evenity.
  • Evenity and Prolia are prescribed for osteoporosis in certain females who have gone through menopause. Prolia can also be used in other people at high risk of bone fractures.
  • Evenity is given more frequently than Prolia. And Evenity isn’t prescribed for more than 12 months.

If you’d like to learn more about Evenity or Prolia, talk with your doctor or pharmacist. They can help answer any questions you have about similarities and differences between the drugs. They can also help determine whether one drug or the other might work well for you.

Note: For more information about your condition, see our lists of articles about osteoporosis and bones and orthopedics.

* Evenity has a boxed warning for this side effect. A boxed warning is a serious warning from the Food and Drug Administration (FDA). To learn more, see “Precautions of Evenity and Prolia” above.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.