M Toronto Myositis Centreat St. Michael's Hospital
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Denosumab

Prolia; biosimilars including Jubbonti · say “den-OH-su-mab”
Bone protection (injection)
!
Do not stop without a plan.

Missing doses or stopping denosumab without a follow-on medication can cause rapid bone loss and spine fractures. Keep every six-month dose on schedule.

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What it is

A twice-yearly injection for bone.

Denosumab is an antibody that slows the cells that break down bone. It is given as an injection every six months to prevent and treat osteoporosis, including the bone loss caused by long-term steroids. Prolia and its biosimilars (such as Jubbonti) are the same medicine and are used the same way; in Canada the biosimilar is now often the covered option.

How to take it
  • Given as a 60 mg injection under the skin every six months, by a nurse or pharmacist.
  • Keep your calcium and vitamin D adequate, since low calcium must be corrected before each dose.
  • Mark your next dose in your calendar. Timing matters with this medication.
What to expect
  • It lowers fracture risk over time; you will not feel a day-to-day change.
  • Its effect wears off after about six months, which is why doses must stay on schedule.
  • If it is ever stopped, your doctor arranges a follow-on medication to protect against rebound bone loss.
Benefits

How it helps you.

Strong fracture protection

Reduces spine and hip fractures, including with steroid-related bone loss.

Twice a year

A simple injection every six months.

An option with kidney issues

Can be used when bisphosphonates are not suitable, including in reduced kidney function.

No special dosing routine

No empty-stomach or stay-upright rules, unlike oral bisphosphonates.

Risks & side effects

What you should know.

Your doctor prescribed this because the expected benefits outweigh the risks for your situation. Here is the honest, full picture.

Common side effects
Injection-site or aches
Mild soreness, or muscle and joint aches, usually short-lived.
Mild reactions
Occasional skin reactions or mild infections.
Serious but uncommon
Low calcium
Can lower blood calcium, especially with kidney disease. Calcium and vitamin D are checked and corrected first.
Rebound fractures if stopped
This is the key risk. Stopping without a follow-on medication can cause rapid bone loss and spine fractures. Do not miss doses.
Jaw osteonecrosis
Rare. A dental check before starting and good dental care lower the risk.
Atypical thigh fracture
Rare, with long use. Report new thigh or groin pain.
!
Never stop denosumab without a follow-on plan.

Denosumab’s effect fades after about six months. Missing a dose or stopping without another bone medication to follow can cause fast bone loss and multiple spine fractures. Keep every dose on schedule, and if it is ever stopped, your doctor will start a bridging medication.

Staying safe

Monitoring and precautions.

Regular monitoring
  • Calcium and vitamin D are checked and corrected before each dose.
  • Kidney function is checked, since low kidney function raises the risk of low calcium.
  • A dental check is recommended before starting.
  • Bone density is followed over time.
Daily precautions
  • Keep every six-month dose on schedule, and never stop without your doctor arranging a follow-on medication.
  • Maintain calcium and vitamin D.
  • Keep up dental care and tell your dentist you receive denosumab.
  • Report symptoms of low calcium (tingling, muscle cramps) promptly.
When to call your doctor

Contact the clinic if you notice:

Numbness, tingling, or cramps
May signal low calcium. Report promptly.
Jaw pain or dental problems
Jaw pain, or a dental site that will not heal. Report it.
New thigh or groin pain
Can rarely precede an atypical fracture. Report it.
A missed or overdue dose
Contact the clinic to reschedule quickly, since timing matters.
Signs of infection
Fever or a skin infection near the injection site.

Pregnancy & breastfeeding

Denosumab is avoided in pregnancy, and effective contraception is advised during treatment. Tell your doctor if you are pregnant or planning, so bone protection can be reviewed.

!

This guide is for education, not medical advice. Myositis treatment is individual, and many of these medications are used based on specialist experience and evidence rather than a formal Canadian myositis indication. Never start, stop, or change a medication without your own doctor. Your doses and choices are decided with your care team at the Centre.

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