A woman with osteoporosis and eGFR 18 mL/min/1.73 m² is being considered for denosumab. Corrected calcium is low and 25-hydroxyvitamin D is 19

Question

A woman with osteoporosis and eGFR 18 mL/min/1.73 m² is being considered for denosumab. Corrected calcium is low and 25-hydroxyvitamin D is 19 nmol/L. Which plan best addresses the treatment-specific risk?

Accepted Answer

Correct the deficiencies before denosumab and monitor serum calcium closely

Answer

Reduce denosumab to 30 mg because renal clearance halves below eGFR 30

Answer

Use intravenous zoledronate first because it is safer in severe renal impairment

Answer

Replace calcium monitoring with a pre-dose DXA scan

Answer

Give the standard dose immediately because denosumab cannot affect calcium in CKD

Vitamin D deficiency — SCE Rheumatology MCQ

A woman with osteoporosis and eGFR 18 mL/min/1.73 m² is being considered for denosumab. Corrected calcium is low and 25-hydroxyvitamin D is 19 nmol/L. Which plan best addresses the treatment-specific risk?