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We present a patient who developed severe hypocalcaemia after administration of denosumab in the context of severe vitamin D deficiency and a normal kidney function. The management was further complicated by hypophosphatemia. Following replacement of vitamin D, the patient\u2019s calcium and phosphate levels stabilised. The patient required intensive care monitoring for replacement of electrolytes. This case report emphasises the importance of screening and ongoing monitoring of risk factors for iatrogenic hypocalcaemia with denosumab treatment.<\/jats:p>","DOI":"10.1136\/bcr-2020-234508","type":"journal-article","created":{"date-parts":[[2020,8,27]],"date-time":"2020-08-27T02:30:20Z","timestamp":1598495420000},"page":"e234508","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Denosumab-induced severe hypocalcaemia in a patient with vitamin D deficiency"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4627-1386","authenticated-orcid":false,"given":"Natasha","family":"Daga","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Central Coast Local Health District, Gosford, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavian","family":"Joseph","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Central Coast Local Health District, Gosford, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,8,26]]},"reference":[{"key":"2025082703083136000_13.8.e234508.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa044459"},{"key":"2025082703083136000_13.8.e234508.2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2007-2814"},{"key":"2025082703083136000_13.8.e234508.3","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.070809"},{"key":"2025082703083136000_13.8.e234508.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2008.04.007"},{"key":"2025082703083136000_13.8.e234508.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0809493"},{"key":"2025082703083136000_13.8.e234508.6","unstructured":"Amgen Australia Pty Ltd . 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