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Denosumab hypocalcaemia — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsDenosumab hypocalcaemiaGPhC CRA

A patient with stage 4 chronic kidney disease is due denosumab today. Corrected calcium is below range, vitamin D supplementation has lapsed and the patient reports new perioral tingling. What is the most appropriate plan?

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Correct answer: C — Defer the dose, correct calcium and vitamin D, then arrange calcium monitoring

Pre-existing hypocalcaemia must be corrected before denosumab. Advanced renal impairment increases hypocalcaemia risk, and perioral tingling is a compatible symptom requiring prompt assessment. Administration should be deferred while calcium and vitamin D status are corrected and a suitable post-dose monitoring plan is arranged. Dose halving or a single calcium dose does not remove the risk.

Reference: Prolia 60 mg SmPC: https://www.medicines.org.uk/emc/product/568/smpc