Reclast vs. Prolia: Differences, similarities, and which is better for you

Various treatment options are available for bone loss caused by osteoporosis or other conditions. A healthcare provider may recommend a bisphosphonate drug like Reclast (zoledronic acid) as a first-line treatment option. However, Prolia (denosumab) is also an effective treatment option. 

Both Reclast and Prolia can help treat osteoporosis in men and postmenopausal women. They can help increase bone density and reduce the risk of spinal and hip fractures, among other bone fractures. While Reclast and Prolia are brand-name prescription drugs used for similar purposes, they differ in several ways. 

Continue reading to learn more about the similarities and differences between Reclast and Prolia. 

What are the main differences between Reclast and Prolia?

The main differences between Reclast and Prolia are in their active ingredients, dosages, and uses. Let’s explore some of these differences here. 

Active ingredients

Reclast and Prolia belong to different drug classes. Reclast contains zoledronic acid, which is a bisphosphonate. It works by binding to an enzyme on osteoclasts, bone cells that break down bone tissue in a process called bone resorption. Other bone cells called osteoblasts then build new bone tissue to maintain the strength and health of the bone. 

Prolia contains denosumab. It is classified as a monoclonal antibody and works by binding to a protein called RANKL, which is involved in bone resorption. By blocking the function of RANKL, denosumab helps slow the growth and function of osteoclasts, which leads to slowed bone loss and increased bone mineral density (BMD).

Method of administration

Both Reclast and Prolia are administered as injections. However, Reclast is administered as an infusion through the vein (intravenously or IV). Prolia is given as an injection under the skin (subcutaneously or SQ). 

Dosage 

Reclast is usually given as a 5 mg infusion over 15 minutes. It is given once per year or every two years for the treatment or prevention of postmenopausal osteoporosis. For Paget’s disease, Reclast is given as a single infusion. 

Prolia is given as 60 mg once every six months in the stomach area, upper arm, or upper leg. The same dosage of Prolia is used for all of its approved indications. 

In the table and following sections below, we’ll dive deeper into other differences between Reclast and Prolia. In addition to their active ingredients, dosage, and administration, these drugs may also differ in their approved uses and potential side effects. 

	Reclast	Prolia
Drug class	Bisphosphonate	Monoclonal antibody
Brand/generic status	Brand and generic available	Brand only
What is the generic name?	Zoledronic acid	Denosumab
What form(s) does the drug come in?	Injection; intravenous (IV) infusion	Injection; subcutaneous (SQ)
What is the standard dosage?	5 mg once, once per year, or once every 2 years, depending on the condition being treated	60 mg once every 6 months
How long is the typical treatment?	Long-term treatment of 3 to 5 years, depending on the response to treatment	Up to 10 years more or less, depending on the response to treatment
Who typically uses the medication?	Adults or people over the age of 18 without severe kidney disease	Adults or people over the age of 18

Conditions treated by Reclast and Prolia

Reclast and Prolia are both FDA-approved for the treatment of osteoporosis in men and postmenopausal women. They are also approved to treat bone loss caused by steroids in men and women at a high risk of fractures. 

Unlike Prolia, Reclast is approved to prevent osteoporosis in postmenopausal women and steroid-induced osteoporosis in men and women. It can also treat Paget’s disease, a chronic bone disorder that causes bone tissue to break down. 

Prolia differs from Reclast in that it is also approved to increase bone mass in men taking androgen deprivation therapy for prostate cancer and women taking aromatase inhibitors for breast cancer. Androgen deprivation therapy and aromatase inhibitors are known to cause negative effects on BMD. 

Reclast and Prolia are not approved for bone conditions in children. 

Condition	Reclast	Prolia
Treatment of postmenopausal osteoporosis	Yes	Yes
Prevention of postmenopausal osteoporosis	Yes	No
Treatment to increase bone mass in men with osteoporosis	Yes	Yes
Treatment of steroid-induced osteoporosis	Yes	Yes
Prevention of steroid-induced osteoporosis	Yes	No
Treatment of Paget’s disease	Yes	Off-label
Treatment to increase bone mass in men taking androgen deprivation therapy for prostate cancer	Off-label	Yes
Treatment to increase bone mass in women taking aromatase inhibitors for breast cancer	Off-label	Yes

Is Reclast or Prolia more effective?

Both Reclast and Prolia are effective treatment options for bone loss. The best treatment option will depend on the condition being treated, an individual’s health condition, and other factors.

Clinical studies and guidelines show that certain bisphosphonates, such as Reclast, Actonel (risedronate), and Fosamax (alendronate), as well as Prolia can be used as first-line treatment options. Reclast and Prolia are particularly beneficial for people at high risk of bone fractures with risk factors such as older age, glucocorticoid use, and increased fall risk. 

In a head-to-head clinical trial comparing Reclast and Prolia, researchers found that people taking Prolia experienced higher spine bone density than those taking Reclast. However, both groups of people reported similar patient satisfaction.

It’s important to consult a healthcare provider for the best treatment option. Various underlying problems can cause bone loss. A healthcare provider can find the best tailored solution for your situation. 

Coverage and cost comparison of Reclast vs. Prolia

Reclast and Prolia can be expensive treatment options as they’re not available as generic drugs. They’re also typically administered in a hospital or clinical setting, which can come with additional costs. 

Reclast may be covered by some private insurance plans. However, it is not typically covered by Medicare Part D or Medicare Advantage plans. Reclast may be covered by part A if the infusion is delivered in an inpatient hospital or part B if the infusion is administered in an outpatient setting. The average retail cost for one Reclast infusion ranges from $1,000 to $2,000.

Prolia may be covered by some insurance plans. When it comes to Medicare coverage, Medicare Part D and Medicare Advantage plans usually help cover the cost of Prolia. The average cash price of one Prolia injection can range from $1,500 to $3,000.

A SingleCare discount card may be able to help lower the cost of Reclast and Prolia. Check with the healthcare professional who will be administering the drug to see if your costs may be lowered with SingleCare. 

	Reclast	Prolia
Typically covered by insurance?	Yes	Yes
Typically covered by Medicare Part D?	No	Yes
Quantity	5 mg/100 mL	60 mg/1 mL
Typical Medicare copay	Varies	Varies
SingleCare cost	$71–$270	$1,563–$1,671

Common side effects of Reclast vs. Prolia

Reclast and Prolia may cause similar side effects. The most common side effects of Reclast are fever, muscle pain, joint pain, headache, flu-like symptoms, nausea, and diarrhea. The most common side effects of Prolia are muscle pain, back pain, pain in the arms or legs, high cholesterol, high blood pressure, and bladder infections. 

These drugs may cause other possible side effects. However, mild side effects are usually temporary and fade over time. Severe side effects may include allergic reactions, low calcium levels in the blood, and jaw bone problems (see Warnings of Reclast and Prolia).

	Reclast		Prolia
Side Effect	Applicable?	Frequency	Applicable?	Frequency
Fever	Yes	19%	No	–
Muscle pain	Yes	12%	Yes	3%
Joint pain	Yes	24%	Yes	7%
Back pain	Yes	2%	Yes	5%
Headache	Yes	12%	Yes	4%
Flu-like symptoms	Yes	3%	Yes	3%
Stomach upset	Yes	4%	Yes	3%
Nausea	Yes	9%	Yes	–
Vomiting	Yes	5%	Yes	3%
Diarrhea	Yes	6%	No	–
High cholesterol	No	–	Yes	7%
Bladder infection	No	–	Yes	6%
Lung infection	No	–	Yes	4%
High blood pressure	Yes	13%	Yes	4%

This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.

Source: DailyMed (Reclast), DailyMed (Prolia)

Drug interactions of Reclast vs. Prolia

Reclast may interact with antibiotics called aminoglycosides and loop diuretics or “water” pills. Taking Reclast with these prescription drugs may increase the risk of low blood calcium levels (hypocalcemia). 

In addition, Reclast may interact with nonsteroidal anti-inflammatory drugs (NSAIDs) and medications that are processed in the kidneys, such as digoxin. Taking Reclast with these medications could increase the risk of kidney damage. 

There are currently no known severe drug interactions with Prolia. 

Drug	Drug Class	Reclast	Prolia
Gentamicin Amikacin Tobramycin	Aminoglycosides	Yes	No
Furosemide Bumetanide Torsemide	Loop diuretics	Yes	No
Ibuprofen Naproxen Diclofenac	NSAIDs	Yes	No
Digoxin	Cardiac glycosides	Yes	No

Consult a healthcare professional for other possible drug interactions

Warnings of Reclast and Prolia

Although both Reclast and Prolia are effective for bone loss, they may carry risks for serious adverse effects. It’s important to consult a healthcare provider if you experience any of the following problems.

Hypocalcemia

Reclast and Prolia can sometimes cause low calcium levels in the blood. A healthcare provider will recommend taking calcium and vitamin D supplements to counteract this problem.

Osteonecrosis of the jaw (ONJ)

In rare cases, Reclast and Prolia may contribute to ONJ, which is a painful condition where the jawbone starts to weaken. The risk of ONJ is higher if you’ve had recent dental work or dental surgery.

Abnormal thigh bone fractures

Although uncommon, some people taking Reclast and Prolia have experienced unusual breaks in their thigh bones.

Allergic reactions

Allergic reactions are possible while taking Reclast or Prolia. Seek immediate medical attention if you experience signs or symptoms of an allergic reaction, such as hives, rash, or trouble breathing.

Kidney problems

In addition to these adverse effects, Reclast may also cause kidney problems. People with severe kidney problems, kidney failure, or a creatinine clearance of less than 35 mL per minute should not use Reclast. 

Serious infections and skin problems

Prolia may cause serious infections or skin problems. It’s important to watch for signs of illness or skin changes while taking this medication. 

Frequently asked questions about Reclast vs. Prolia

What is Reclast?

Reclast is a medicine used to treat osteoporosis, a condition that weakens bones. It contains zoledronic acid, which helps slow down bone loss and increase bone strength. Reclast is given as an injection in a vein (IV) by a healthcare professional.

What is Prolia?

Prolia is another medicine for osteoporosis. It contains denosumab, which blocks a protein involved in bone breakdown. Prolia is given as a shot under the skin (subcutaneous injection) by a healthcare professional.

Are Reclast and Prolia the same?

No, Reclast and Prolia are not the same. They have different active ingredients and work in different ways to treat osteoporosis. Reclast contains zoledronic acid, while Prolia contains denosumab.

Is Reclast or Prolia better?

Both Reclast and Prolia are effective for osteoporosis, but which one is better depends on the individual. Doctors consider factors like age, medical history, and potential side effects to determine the best treatment. Consult your doctor or healthcare provider to determine which option is right for you.

Can I use Reclast or Prolia while pregnant?

No, you should not use Reclast or Prolia if you’re pregnant. Both medications can harm an unborn baby. If you’re planning to become pregnant or are already pregnant, talk to your doctor or healthcare provider about other treatment options.

Can I use Reclast or Prolia with alcohol?

It’s best to avoid alcohol when using Reclast or Prolia. Alcohol can weaken the bones and increase the risk of side effects. If you have concerns about alcohol use and your treatment, speak with your doctor or healthcare provider.

What is better than Prolia for osteoporosis?

The best treatment for osteoporosis depends on the person, the underlying condition, and other factors. Alternatives to Prolia generally include bisphosphonates, such as Reclast, Actonel, and Fosamax. Bisphosphonates are typically available as generic drugs that may be cheaper than brand-name medications. Consult your doctor or healthcare provider to find the best treatment for your situation.