Possible Interaction: Denosumab and Calcium Supplement

“A single dose (120 mg) of denosumab was given and his calcium level plummeted from 14.8 mg/dL to 5.5 mg/dL. After second lung metastasectomy, he developed prolonged hypocalcaemia that required calcium and vitamin D supplements for more than 3 years.”

“Compared with denosumab monotherapy, combination therapy of denosumab plus vitamin D and calcium significantly increased H-BMD at 12 months and L-BMD from 24 to 48 months.”

“To avoid serious prolonged hypocalcemia, a thorough assessment of the bone calcium metabolism is required before initiating denosumab treatment.”

“Compared with denosumab monotherapy, combination therapy of denosumab with vitamin D and calcium significantly increased H-BMD in patients having OP with RA.”

“Thus, calcium should be closely monitored with the use of denosumab.”

“Supplementation of calcium and vitamin D is strongly recommended when patients initiate denosumab therapy, particularly in patients with reduced renal function.”

“Interestingly, Fizazi et al showed that a calcium decrease of grade 3 or higher occurred in 48 patients (5%) receiving denosumab and 13 patients (1%) receiving zoledronic acid, which demonstrated the potentially more potent effect of denosumab in malignant hypercalcemia.”

“ DMAb and ALN decreased serum calcium ( Ca ), and transition from ALN to DMAb resulted in a lesser decline in Ca relative to DMAb or to VEH‐DMAb transition.”

“In advanced bone disease, treatment with denosumab should be considered, ensuring a strict control of Ca levels.”

“Checking calcium and vitamin D levels prior to the administration of Denosumab is vital in preventing hypocalcemia.”