DENOSUMAB-DSSB (OSPOMYV) - FOR CLINIC INFUSION CENTERS USE ONLY		version 6/23/2026		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room	Every 24 weeks	S	2 treatments	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine		

Provider Communication 	

	
	Interval	Defer Until	Duration	
	☐	Provider communication	Every visit	S	Until discont'd	
		Add Phosphorus and Magnesium in patients with history of hypoparathyroidism, thyroid surgery, parathyroid surgery, malabsorption syndromes, excision of small intestine, and CrCl LESS than 30 mL/min.		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Vital signs - T/P/R/BP Per Unit Protocol	Every visit	S	Until discont'd	
		Instruct patient to report symptoms of chills, fever or pain.		
	☐	Nursing communication: Monitor patient for signs of infusion reaction.  If patient has infusion reaction, stop infusion, notify physician, and administer emergency medications as ordered	Every visit	S	Until discont'd	
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	☐	Nursing communication	Every visit	S	Until discont'd	
		o Verify lab results within last 28 days: Calculated Creatinine Clearance (GFR) and Serum Ca2+. 
	o Notify provider if corrected Ca level is less than or equal to 8.5.
	o HOLD for ionized calcium  LESS than 1.11 mmol/L or LESS than 4.7 mg/dL.		
	☐	Nursing communication	Every visit	S	Until discont'd	
		Proceed with treatment prior to Vitamin D resulting.		
	☐	Nursing communication	Every visit	S	Until discont'd	
		Verify patient is on calcium and vitamin D supplementation. Notify provider if the patient is not on calcium and vitamin D supplementation or the patient's calcium level is outside the normal range.		
	☐	Nursing communication	Every visit	S	 treatments	
		If patient has advanced CKD (eGFR LESS than 30) or is on dialysis, provide targeted education on serious risk and symptoms of severe hypocalcemia (e.g., muscle cramps, paresthesias, confusion, seizures) and review Patient Guide prior to administration.		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	Vitamin D 25 hydroxy level	Once	S	1 treatment	
		STAT, Normal, Clinic Collect		
	☐	Basic metabolic panel	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Albumin level	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	hCG quantitative, serum	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Ionized calcium	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		

Medications 	

	
	Interval	Defer Until	Duration	
	☐	denosumab-dssb (OSPOMYV) syringe 60 mg	Every 24 weeks	S	2 treatments	
		60 mg, subcutaneous, once, Starting when released
	For Subcutaneous Route ONLY. Bring syringe or vial to room temp in container. Do not use if cloudy. Avoid shaking.		

Hypersensitivity 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 650 mg	PRN	S	Until discont'd	
		650 mg, oral, every 4 hours PRN, mild pain (score 1-3), Starting when released, Until Discontinued
	Maximum of 4 grams of acetaminophen per day from all sources. (Cirrhosis patients maximum: 2 grams per day from all sources).		
	☐	diphenhydrAMINE (BENADRYL) tablet 25 mg	PRN	S	Until discont'd	
		25 mg, oral, every 6 hours PRN, itching, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	PRN	S	Until discont'd	
		25 mg, intravenous, once PRN, for minor infusion reaction, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 50 mg	PRN	S	Until discont'd	
		50 mg, intravenous, once PRN, for severe infusion reaction, Starting when released, Until Discontinued		
	☐	epINEPHrine (ADRENALIN) injection 1 mg/mL 0.5 mg	PRN	S	Until discont'd	
		0.5 mL, subcutaneous, once PRN, anaphylaxis, Starting when released, Until Discontinued		
	☐	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	PRN	S	Until discont'd	
		100 mg, intravenous, once PRN, for infusion reaction, Starting when released, Until Discontinued		
	☐	promethazine (PHENERGAN) tablet 25 mg	PRN	S	Until discont'd	
		25 mg, oral, every 6 hours PRN, nausea, vomiting, Starting when released, Until Discontinued		
	☐	sodium chloride 0.9% infusion 250 mL	PRN	S	Until discont'd	
		250 mL, intravenous, once PRN, Hydration, Starting when released, Until Discontinued