[Symptomatic hypocalcaemia on denosumab use].

Background: Bone resorption inhibitors such as denosumab may induce symptomatic hypocalcaemia if a vitamin D deficiency is present. Amongst other causes, this type of deficiency may arise following bariatric surgery.
Case Description: We describe a 51-year-old woman who, a few years after undergoing bariatric surgery, developed symptomatic hypocalcaemia after she started taking denosumab.
Conclusion: An adequate calcium and vitamin D status is a general condition before prescribing medication to treat osteoporosis. Therefore we recommend that before starting treatment with a bone resorption inhibitor that not only the calcium but also the vitamin D status should be determined, and if necessary, optimised.