Abstract
Denosumab is a human monoclonal immunoglobulin G2 (IgG2) antibody that is used in the management of osteoporosis and various bone-related disorders to help strengthen bones and prevent fractures. Declining renal function and the drug denosumab are both associated with an increased risk of hypocalcaemia. The combination of both factors in a patient, along with the long half-life of the drug, can cause further exacerbation of this risk. A thorough understanding of pharmacokinetics is therefore essential when encountering drug adverse effects. We present a case of recurrent severe hypocalcaemia secondary to denosumab administration in a patient with chronic kidney disease. This case report highlights the importance of close monitoring of calcium levels in patients with established risk factors for hypocalcaemia, as well as in those who have achieved resolution of denosumab-induced hypocalcaemia.