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Denosumab-associated hypocalcaemia — SCE Endocrinology MCQ

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ModerateCalcium/BoneDenosumab-associated hypocalcaemiaSCE Endocrinology

A 63-year-old woman with breast cancer receives denosumab for bone metastases. She presents with paraesthesia and tetany. Calcium is 1.65 mmol/L and vitamin D is 12 nmol/L. What is the most likely precipitant?

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Correct answer: C — Denosumab-associated hypocalcaemia worsened by vitamin D deficiency

Denosumab can cause clinically significant hypocalcaemia, especially with vitamin D deficiency or renal impairment. Primary hyperparathyroidism causes hypercalcaemia, not tetany with low calcium. Vitamin D and calcium status should be checked before antiresorptive therapy.

Reference: BNF; Society for Endocrinology Hypocalcaemia Guidance