skip to main content

Denosumab Hypocalcaemia — SCE Medical Oncology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateSupportive & Palliative OncologyDenosumab HypocalcaemiaSCE Medical Oncology

A 55-year-old woman with metastatic breast cancer on denosumab 120 mg monthly develops severe hypocalcaemia (corrected calcium 1.85 mmol/L) with muscle cramps, perioral tingling, and positive Chvostek sign. What is the emergency management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — IV calcium gluconate (or calcium chloride via central line), check and replace magnesium, hold denosumab until calcium normalises

Denosumab-induced hypocalcaemia can be severe and symptomatic, particularly in patients with renal impairment, vitamin D deficiency, or extensive bone metastases. Emergency management requires slow IV calcium gluconate infusion (10 mL 10% solution over 10 minutes, repeated as needed), magnesium assessment/replacement (hypomagnesaemia impairs calcium correction), and oral calcium + vitamin D supplementation. Denosumab should be held until calcium normalises. Prophylactic calcium/vitamin D should be co-prescribed with denosumab.

Reference: BNF Denosumab; ESMO 2024 Bone Health Guidelines; MHRA Denosumab Safety