Short answer: Prolia (denosumab) is a 60 mg shot every 6 months that slows bone breakdown. Tymlos (abaloparatide) is an 80 mcg daily self-injection that builds bone, with use over 2 years in a lifetime not recommended.12 Prolia has a boxed warning for severe low calcium in advanced kidney disease and needs a follow-on medicine if stopped. Neither label reports a trial against the other.
| Prolia (denosumab) | Tymlos (abaloparatide) | |
|---|---|---|
| Drug type | RANK ligand inhibitor (slows bone breakdown)1 | PTHrP analog (builds bone)2 |
| Dose | 60 mg under the skin every 6 months, by a healthcare provider1 | 80 mcg under the skin once a day, self-injected; 30 doses per pen2 |
| Approved for | Postmenopausal women and men at high fracture risk; steroid-induced osteoporosis; bone loss from prostate or breast cancer hormone therapy1 | Postmenopausal women at high fracture risk; bone density in men at high fracture risk2 |
| Time limit | None in the label1 | Over 2 years in a lifetime not recommended2 |
| When stopping | Move to another antiresorptive; spine fracture risk rises after stopping1 | In the women's trial, people moved to alendronate after 18 months2 |
| Boxed warning | Severe low calcium in advanced kidney disease1 | None2 |
| Common side effects | Back pain 34.7% vs 34.6%; limb pain 11.7% vs 11.1% (3 years)1 | High urine calcium 11% vs 9%; dizziness 10% vs 6%; nausea 8% vs 3%; palpitations 5% vs 0.4% (18 months)2 |
| Missed dose | Give as soon as possible, then every 6 months from that date1 | Take later that day if possible; never 2 in one day2 |
Prolia blocks RANK ligand, which slows the cells that break bone down. Tymlos acts like parathyroid hormone-related protein, which, given once a day, stimulates bone building.12 That is why Tymlos is a daily injection with a lifetime limit while Prolia is given twice a year with no set end date.21
These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
Which fits depends on fracture risk, kidney function and past treatment, which your prescriber weighs. More detail: Prolia side effects, Tymlos side effects, the Prolia and Tymlos dosing schedules, what to do if you miss a Prolia dose or miss a Tymlos dose, and the Abaloparatide guide.