Short answer: Both treat osteoporosis after menopause.12 Evista (raloxifene) is a 60 mg tablet once a day that also lowers invasive breast cancer risk in some postmenopausal women. Prolia (denosumab) is a 60 mg shot every 6 months from a healthcare provider, also approved for men and for some bone loss from steroids or hormone therapy. Both have boxed warnings. Neither label reports a trial against the other.
| Evista | Prolia | |
|---|---|---|
| Drug | Raloxifene, an estrogen agonist/antagonist1 | Denosumab, a RANK ligand inhibitor2 |
| Approved for | Postmenopausal women: treating and preventing osteoporosis; lowering invasive breast cancer risk1 | Postmenopausal women and men with osteoporosis at high fracture risk; steroid-induced osteoporosis; bone loss from some prostate and breast cancer hormone therapies2 |
| How given | 60 mg tablet once daily, any time, with or without food1 | 60 mg under the skin every 6 months, by a healthcare provider2 |
| Calcium and vitamin D | Added if diet falls short1 | Calcium 1000 mg and at least 400 IU vitamin D daily for everyone2 |
| Side effects in label trials | 3-year treatment trial: hot flashes 9.7% vs 6.4% on placebo, leg cramps 7.0% vs 3.7%, peripheral edema 5.2% vs 4.4%1 | 3-year trial: back pain 34.7% vs 34.6%, pain in arms or legs 11.7% vs 11.1%, high cholesterol 7.2% vs 6.1%2 |
| Missed dose | Take when remembered unless the next dose is near; never two at once1 | Give as soon as possible, then every 6 months from that date2 |
| Boxed warning | Blood clots, and death from stroke in women with or at risk of heart disease1 | Severe low blood calcium in advanced kidney disease2 |
Evista is stopped at least 72 hours before and during long immobilization, such as recovery from surgery or bed rest, because of blood clot risk, and restarted once fully walking.1 Stopping Prolia is different: bone turnover rises above pretreatment levels by 9 months and bone density returns to baseline within 18 months, and new spine fractures have occurred as early as 7 months after the last dose. The label says anyone stopping Prolia moves to another antiresorptive medicine.2
Evista is not used with current or past blood clots or in pregnancy, is not recommended with systemic estrogen, before menopause or in men, and showed no heart benefit.1 Prolia warns about severe low calcium, jaw osteonecrosis, unusual thigh bone fractures, serious infections, skin reactions and bone, joint or muscle pain, and it is not used with low blood calcium or in pregnancy.2 These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
Which, if either, fits is for your prescriber. More detail: Evista side effects, Prolia side effects, the Evista and Prolia dosing schedules, the Evista and Prolia missed-dose pages, Evista vs Fosamax: how do raloxifene and alendronate differ? and Fosamax vs Prolia: how do the weekly tablet and the twice-yearly shot differ?.