Which statement about monitoring after starting denosumab is true?

• A. It has no effect on calcium levels.
• B. Serum calcium does not need monitoring.
• C. Adequate calcium and vitamin D are unnecessary.
• D. Check serum calcium within 1–2 weeks after the first dose and monitor for hypocalcemia; ensure adequate calcium and vitamin D.

Answer: (D)

Monitoring after starting denosumab focuses on preventing and detecting hypocalcemia, because denosumab lowers bone resorption and can cause a rapid drop in serum calcium, especially soon after the first dose. Because of this risk, it’s important to measure calcium levels within 1–2 weeks after the initial dose and watch for signs of hypocalcemia such as tingling, muscle cramps, or confusion. Ensuring adequate calcium and vitamin D is essential before and during therapy, so calcium and vitamin D status should be assessed and corrected as needed to support calcium balance. In practice, baseline checks help identify who may need supplementation, and ongoing monitoring helps catch any delayed declines. Therefore, the recommended approach is to check serum calcium within a couple of weeks after the first dose, monitor for hypocalcemia, and ensure adequate calcium and vitamin D intake.