If at risk for hypocalcemia, labs required within 14 days of each dose: Calcium, magnesium, phosphorus

Each dose must be given every 6months +/- 1 month to avoid rebound risk of fractures

• Each dose must be administered by healthcare professional.
• Should be given in the upper arm, upper thigh, or abdomen

Consider titrating vitamin D supplementation (minimum 400 IU daily) to serum goal of > 30 ng/mL in addition to adequate calcium supplementation

Note: most common side effects include back pain, pain in extremities, hypercholesteremia, musculoskeletal pain, and cystitis

Denosumab also carries risk of serious infection (particularly cellulitis) and dermatitis.

Source: denosumab package insert