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Bone Metastases — SCE Medical Oncology MCQ

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HardSupportive & Palliative OncologyBone MetastasesSCE Medical Oncology

A patient with bone metastases and eGFR 22 mL/min is due to start denosumab 120 mg. Corrected calcium is 1.96 mmol/L and vitamin D is low. What should happen before the first dose?

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Correct answer: E — Defer denosumab, correct hypocalcaemia and vitamin-D deficiency, provide calcium/vitamin-D supplementation and plan intensified calcium monitoring

Pre-existing hypocalcaemia must be corrected before denosumab. Severe renal impairment increases the risk of clinically important hypocalcaemia, so supplementation and close monitoring are essential, although dose adjustment for renal clearance is not required. Dental assessment is also important but cannot override the biochemical contraindication.

Reference: Xgeva 120 mg UK summary of product characteristics (Current UK SmPC, accessed August 2026): https://www.medicines.org.uk/emc/product/4675/smpc