Experience with denosumab in the treatment of bone diseases in pediatrics at a tertiary care hospital.

Denosumab has been shown to improve post-surgical morbidity in resectable lytic bone neoplasms with high RANK-L expression and to halt disease progression in unresectable cases. Intra- and post-treatment adverse effects have been reported. We conducted a prospective, descriptive study including six patients with lytic bone neoplasms treated with denosumab. The median age at onset treatment was 7.4 years, and the male-to-female ratio was 5:1. Five patients showed a favorable response. All patients developed hypocalcemia and hypophosphatemia during treatment, requiring adjustments in calcium and ergocalciferol/cholecalciferol supplementation (6/6), the addition of calcitriol (5/6), and phosphate salts (3/6). Metaphyseal bands were observed in 4 out of 6 patients. No fractures were reported, and most patients did not show evidence of impaired growth. Four patients experienced post-treatment hypercalcemia. Risk factors included younger age, a higher number of doses, and the presence of metaphyseal bands.