Suspected Denosumab-Associated Acute Coronary Syndrome
Matthew Maharaj1, Arun Katwaroo1, Priya Ramcharan2
1Department of Medicine, North West Regional Health Authority, Port of Spain, Trinidad and Tobago.
Journal of Investigative Medicine High Impact Case Reports
|August 3, 2026
Summary
Denosumab, a monoclonal antibody targeting RANKL, may increase the risk of acute coronary syndrome. This case report highlights a potential link between denosumab treatment and myocardial infarction in a patient without traditional cardiovascular risk factors.
Area of Science:
- Cardiology
- Oncology
- Pharmacology
Background:
- Denosumab, a monoclonal antibody targeting receptor activator of nuclear factor-κB ligand (RANKL), is used for bone diseases and giant cell tumors.
- Emerging evidence suggests RANKL inhibition may affect cardiovascular health through various pathways.
Purpose of the Study:
- To report a case of acute coronary syndrome in a patient treated with denosumab.
- To explore the potential association between denosumab and myocardial infarction.
Main Methods:
- Case report of a 48-year-old man with recurrent giant cell tumors treated with denosumab.
- Clinical presentation, coronary angiography, and treatment of ST-elevation acute coronary syndrome.
- Review of potential biological mechanisms linking RANKL inhibition to atherothrombotic events.
Main Results:
- The patient developed an anterior ST-elevation acute coronary syndrome shortly after receiving denosumab.
- Coronary angiography showed thrombotic occlusion of the left anterior descending artery.
- The event occurred in the absence of traditional cardiometabolic risk factors.
Conclusions:
- A denosumab-associated myocardial infarction was considered the most probable cause of the patient's acute coronary syndrome.
- This case suggests a potential link between denosumab and atherothrombotic cardiovascular events.
- Further research is warranted to investigate the cardiovascular safety of denosumab.
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