Name an adverse effect and monitoring need specific to denosumab therapy.

• A. Hypocalcemia risk; monitor serum calcium after initiation and ensure adequate calcium and vitamin D intake; assess for signs of infection and jaw osteonecrosis
• B. Hypercalcemia risk; monitor potassium; assess for hair loss
• C. Kidney stones; monitor urinalysis; assess for liver toxicity
• D. Anemia; monitor hemoglobin; assess for infection

Answer: (A)

Denosumab works by blocking RANKL, which reduces osteoclast activity and bone resorption. Because calcium is no longer being released from bone as readily, there is a real risk of hypocalcemia after starting therapy. This risk is why monitoring focuses on serum calcium soon after initiation—typically within the first week to a couple of weeks—and on ensuring adequate calcium and vitamin D intake to support normal calcium levels. Patients should be educated to recognize symptoms of low calcium such as tingling, muscle cramps, or numbness, and clinicians may adjust supplements as needed.

Another important, therapy-specific concern is osteonecrosis of the jaw. Denosumab can increase this risk, especially around dental procedures or in the presence of dental infection, so a dental evaluation before starting treatment and ongoing monitoring for jaw pain, swelling, or non-healing dental wounds are advised. Together, these monitoring needs—watching calcium levels and protecting oral health—address the most characteristic adverse effects of denosumab and guide safe use.