Denosumab is used to for the treatment of osteoporosis. Learn how to use the medication, its common side effects, special precautions to watch out for, and more.

What is this medication for?

Denosumab is used for the treatment of osteoporosis, a condition where bone content is lost faster than replaced, leading to weak, brittle bones that are prone to fractures. It is available as a 60mg prefilled injection syringe.
Bones in the body are regularly broken down and rebuilt to maintain bone strength. Denosumab works by reducing bone breakdown, thereby increasing bone mass and lowering the risk of fracture. 
Denosumab needs to be taken regularly for a long period of time to get its benefits. You should have an adequate intake of Calcium and Vitamin D (from food or supplements) to strengthen your bones. Calcium is the major building block of bone, and Vitamin D helps in the absorption of calcium by the body.
To reduce the risk of osteoporosis, you should engage in weight-bearing and muscle-strengthening exercises, stop smoking and consume alcohol in moderation. 

This leaflet will not address the use of Denosumab 120mg available for the treatment of cancer-related bone conditions. The two strengths are not to be used interchangeably.
 

How should I take or use this medication?

Denosumab is administered by a trained doctor or nurse. It is administered under the skin (subcutaneous) in the abdomen, upper arm or upper thigh  every 6 months. Do not rub or scratch the injection area.

What should I do if I forget to take or use this medication?

If a dose is missed, reschedule your appointment with your clinic as soon as possible; fracture risk may be increased if dose is not administered within 7 months of the previous dose. Thereafter, schedule doses every 6 months from the date of last injection. 

What precautions should I take when taking or using this medication?

Inform your healthcare professional if: 

• You are allergic to this medication or any of the other ingredients of this medication.
• You are pregnant, planning to become pregnant, or breastfeeding
• You have any existing kidney problems

What are some common side effects of this medication?

• You may experience slight skin irritation over the injection area.
• Mild muscle, joint and back pain
• Skin rashes
  • Seek medical advice if rashes are serious and spread over your whole body 

What are some rare but serious side-effects that I need to seek medical advice immediately?

These rare but serious side-effects may occur when you use this medication. Seek medical advice immediately if they do occur .

• Symptoms of a drug allergy include one or more of the following:
  • Swollen face/eyes/lips/tongue
  • Difficulty in breathing
  • Itchy skin rashes over your whole body
• Due to low calcium levels, you may experience muscle cramps, numbness and tingling sensation in your lips or tongue, irregular heartbeat
  • Blood tests may be done to monitor your calcium levels
  • Ensure daily intake of calcium and vitamin D whilst undergoing treatment -these can be from dietary or supplement sources.
• You may experience jaw pain, toothache, gum ulceration, delayed wound healing in mouth
  • You will be referred to a dentist to assess whether you can be started on  denosumab.
  • Ensure good oral hygiene and always inform your dentist that you are on this medication to avoid this rare but serious side effect.
• You may experience thigh or groin pain weeks or months with minimal or no injury to the area before the fracture occurs
  • You will be scheduled for bone scans every few years to assess the need to continue or temporarily stop denosumab
• Infection
  • Denosumab may increase the risk for infections, in particular the skin, ear and urinary tract.
  • Ensure good hygiene and avoid sick contact. Look out for signs of infection including fever and chills and seek medical advice.

If you experience any of the above symptoms, you should seek medical attention immediately

How should I store this medication?

Store in the refrigerator between 2-8°C. Do not freeze. Keep this medication away from children. 

What else should I know about this medication?

You will be scheduled for bone scans every few years when on denosumab. Depending on the results of the scan, your doctor may continue or stop denosumab. If bone mass does not improve while on denosumab, you may be switched to another medication.

Disclaimer

Please take note that the above is not a complete list of all possible side effects. If you have any concerns about your medication or if you have other side effects that you think are caused by this medication, please consult your doctor or pharmacist.

If you take more than the recommended dose, please seek medical advice immediately. The information provided on this page does not replace information from your healthcare professional. Please consult your healthcare professional for more information.

This article is jointly developed by members of the National Medication Information workgroup. The workgroup consists of cluster partners (National Healthcare Group, National University Health System and SingHealth), community pharmacies (Guardian, Unity and Watsons) and Pharmaceutical Society of Singapore. The content does not reflect drug availability and supply information in pharmacies and healthcare institutions. You are advised to check with the respective institutions for such information.

Last updated July 2025