From the Guidelines
Before receiving repeat Prolia (denosumab) injections every 6 months, patients should have their calcium, vitamin D, and kidney function levels checked, as recommended by the most recent guidelines 1.
Recommended Lab Tests
The following lab tests are recommended before each injection:
- Serum calcium
- 25-hydroxyvitamin D
- Creatinine tests These tests are crucial because Prolia can cause hypocalcemia (low calcium), especially in patients with vitamin D deficiency or kidney problems.
Additional Considerations
Additionally, a bone mineral density (BMD) test is typically performed every 1-2 years to monitor treatment effectiveness, though not necessarily before each injection. Some providers may also check parathyroid hormone (PTH) levels in patients with complex cases.
Timing of Lab Tests
These laboratory tests should ideally be done 1-2 weeks before the scheduled injection to allow time for any necessary interventions if abnormalities are found.
Supplements
Patients should continue their daily calcium (1000-1200 mg) and vitamin D (800-1000 IU) supplements while on Prolia therapy, as these supplements help prevent hypocalcemia and support bone health during treatment, as supported by recent studies 1.
Monitoring for Adverse Effects
Monitoring of creatinine clearance is not required for denosumab, but serum calcium monitoring is required, with repletion as needed, to prevent hypocalcemia, a common adverse effect of denosumab 1.
From the FDA Drug Label
In patients with advanced chronic kidney disease [i.e., estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2], including dialysis-dependent patients, evaluate for the presence of chronic kidney disease mineral and bone disorder (CKD-MBD) with intact parathyroid hormone (iPTH), serum calcium, 25(OH) vitamin D, and 1,25 (OH)2 vitamin D prior to decisions regarding Prolia treatment The lab testing before repeat Prolia injections every 6 months are not explicitly stated for all patients, but for patients with advanced chronic kidney disease, the following lab tests are recommended:
From the Research
Lab Testing Before Repeat Prolia Injections Every 6 Months
- The following lab tests are relevant before repeat Prolia injections every 6 months:
- Serum calcium levels: to monitor for hypocalcemia, a potential side effect of denosumab treatment 3, 4, 5, 6, 7
- Creatinine levels: to assess renal function, as impaired renal function may increase the risk of hypocalcemia 3, 4, 5, 6
- Albumin-adjusted serum calcium concentration: to accurately assess serum calcium levels 3, 4, 6
- 25-hydroxyvitamin D concentration: to ensure adequate vitamin D supplementation 4, 6
- The frequency and type of lab tests may vary depending on individual patient factors, such as renal function and history of hypocalcemia 5, 6
- Regular monitoring of serum calcium levels is recommended to identify and prevent severe hypocalcemia 6
- A baseline serum calcium level ≤ 9.31 mg/dL may predict hypocalcemia with a sensitivity of 77% and specificity of 56% 6
- Other risk factors for hypocalcemia, such as age ≥ 65 years, grade 1 or higher serum alkaline phosphatase elevation, and co-administration of cytotoxic agents, should also be considered 7