Denosumab Hypocalcaemia CKD — ESENeph MCQ

Correct answer: E — Correct calcium and vitamin D before denosumab treatment

The best answer is “Correct calcium and vitamin D before denosumab treatment”. The Prolia SmPC requires hypocalcaemia to be corrected before treatment, adequate calcium and vitamin D, and especially regular calcium monitoring in severe renal impairment or dialysis. “Give denosumab now because renal impairment prevents hypocalcaemia” is less appropriate because severe renal impairment and dialysis increase rather than remove this risk “Reduce the denosumab dose according to eGFR without calcium checks” is less appropriate because the product information does not solve risk through renal dose reduction and specifically emphasises calcium assessment “Substitute an intravenous bisphosphonate without renal assessment” is less appropriate because bisphosphonates have their own renal restrictions and this does not address the existing mineral abnormality “Measure calcium after 6 months as the first safety test” is less appropriate because baseline correction and early monitoring are required because severe symptomatic events often occur in the first weeks

Reference: Prolia Summary of Product Characteristics: https://www.medicines.org.uk/emc/product/568/smpc