Would you stop denosumab in a patient with chronic kidney disease if they develop asymptomatic hypocalcemia after the injection?

No. Stopping denosumab leads to rebound bone resorption and loss of all gains. The hypocalcemia indicates insufficient calcium and/or calcitriol. Calcium intake should be 1,000-1,200 mg daily from food and/or supplements in divided doses with food.

No, please do not stop. Check Calcium levels 7 days after Denosumab injection and if asymptomatic hypocalcemia noted- increase calcium supplement to 2000 mg for 2-3 weeks.

Full disclosure: I have not used it but everything I read about using it in CKD, at least in ESRD is that it can lead to profound extended hypocalcemia, so I wonder about it being started in the first place (to find that patient that has asymptomatic hypocalcemia). I suppose too what level of CKLD y...

Agree with not stopping and increasing calcium/calcitriol. Is reduced dose Prolia going to become more widely available, especially in this scenario?