Dose-specific effects of denosumab on serum calcium levels in patients with osteoporosis and various renal functions

Patients with osteoporosis and advanced chronic kidney disease (CKD) are at increased risk for hypocalcemia when initiating denosumab. It remains unclear if subsequent doses of denosumab pose similar hypocalcemia risk as the initial dose does. To study dose-specific hypocalcemia risks of denosumab. An observational study of 10,398 consecutive patients with varying renal function who received denosumab within Mass General Brigham healthcare system between 1/1/2016 and 2/29/2024. Dose-specific effects of denosumab on serum calcium levels and incidence of hypocalcemia (albumin-corrected serum calcium level < 8.5 mg/dl). In 159 patients with sufficient data for three consecutive doses of denosumab, the initial dose of denosumab reduced serum calcium levels by an average of 0.34, 0.52, and 1.12 mg/dl, in patients with GFR of ≥60 (n=89), 30-59 (n=46) and < 30 (n=24) ml/min/1.73m2, respectively (p