Denosumab safety — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsDenosumab safetyGPhC CRA

A patient is due denosumab for osteoporosis and reports perioral tingling after several weeks of poor intake. They have advanced CKD. What should the pharmacist recommend?

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Correct answer: C — Defer denosumab and urgently assess and correct hypocalcaemia

Defer denosumab and urgently assess and correct hypocalcaemia: Perioral tingling is compatible with symptomatic hypocalcaemia; advanced CKD magnifies denosumab-associated risk, so calcium and vitamin-D abnormalities must be assessed and corrected before dosing. Give denosumab after one calcium dose and test within seven days: A single empirical supplement does not establish or correct the severity of symptomatic hypocalcaemia before exposure. Defer denosumab until scheduled renal review and measure calcium then: The possible symptomatic electrolyte disturbance requires urgent calcium assessment, not simply delayed dosing. Give intravenous zoledronate after checking calcium alone: An alternative antiresorptive does not treat current hypocalcaemia and also requires full mineral and treatment-suitability review. Stop denosumab permanently without an alternative treatment plan: Immediate dosing should be deferred, but unplanned permanent cessation can expose the patient to rebound vertebral-fracture risk.

Reference: Prolia UK summary of product characteristics: https://www.medicines.org.uk/emc/product/568/smpc; BNF: denosumab: https://bnf.nice.org.uk/drugs/denosumab/