Xgeva: What to Expect Side Effects, and More
If you’ve been diagnosed with breast cancer that has spread to the bones, your doctor may prescribe Xgeva (chemical name: denosumab) to ease any bone pain you may have and help reduce the risk of serious bone problems, such as breaking a bone, the need for surgery or radiation to bones, or spinal cord compression. Xgeva is prescribed in addition to whatever you are receiving for treatment of the cancer.
See Xgeva prescribing information.
How Xgeva works
Xgeva is a RANKL inhibitor. The medicine works by blocking the signals to the cells that break down bone. RANKL inhibitors also can help keep blood calcium levels normal. This is important because bone damage may increase blood calcium levels.
What to expect during Xgeva treatment
Xgeva is given as an injection under the skin in the upper arm, upper thigh, or abdomen. When treating breast cancer that has spread to the bones, the typical dose is 120 mg every four weeks. Xgeva is generally prescribed for at least two years.
Xgeva side effects
Like almost all breast cancer medicines, Xgeva can cause side effects, some of them severe.
The most common Xgeva side effects are:
low levels of phosphate in the blood
low levels of calcium in the blood
Serious side effects include hypercalcemia (too much calcium in the blood), severe jaw problems (osteonecrosis of the jaw), and thigh bone fractures.
People who are pregnant or planning to get pregnant should not take Xgeva. Xgeva can harm the developing fetus. If there’s any chance you can become pregnant, you should use birth control while you’re taking Xgeva and for at least five months after stopping the medication.
If you’re breastfeeding or plan to breastfeed, talk with your doctor about the potential risks of taking this medication.
Real patient reviews
Members of our community discuss their experiences with Xgeva in the community forum. Here are some of their comments. Remember, it's very important to talk to your doctor about any side effects you're having and ask about ways to manage them.
“My side effects so far: weight loss, no appetite, and my teeth are sensitive.” —dixiebell
“I was on Xgeva for one and a half years and had no side effects.” —SonnyB
“I've been on Xgeva for over a year now. I do notice that my teeth are more sensitive at the dentist, but other than that, no side effects. No shortness of breath here. I'm training for NYC Marathon :)” —Rseman
Read more in our Xgeva discussion forum.
Paying for Xgeva
The cost of Xgeva may vary. The price you’ll pay depends on the drug manufacturer, your health insurance provider and plan, where you live, and the pharmacy you use.
Note: Your insurance company may require prior authorization before covering Xgeva.
Amgen also offers a SupportPlus Co-pay Program that can help.
Learn more about financial assistance and medicine cost-lowering tips.
Xgeva biosimilars
Xgeva is a biologic medicine. This means that it is made from living organisms, in this case a human antibody.
Four biosimilars of Xgeva are approved by the U.S. Food and Drug Administration (FDA):
Bilprevda (chemical name: denosumab-nxxp)
Osenvelt (chemical name: denosumab-bmwo)
Wyost (chemical name: denosumab-bbdz)
Xbryk chemical name: (denosumab-dssb)
Like generics, biosimilars are less expensive versions of medicines already approved by the FDA. Multiple studies must show that the biosimilar is as safe and effective as the original biologics before the FDA will consider approving them.
— Last updated on September 6, 2025 at 4:02 PM
