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All osteoporosis patients should be instructed on the importance of calcium and vitamin D supplementation in maintaining serum calcium levels [see Dosage and Administration (2.8), Adverse Reactions (6.1), Patient Counseling Information (17)]

[14] Recognize that biologics can lead to rare side effects that include developing nervous system disorders such as multiple sclerosis, blood disorders, and certain types of cancer

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PMID 2595433

Patient #4 has a history of psoriatic arthritis that has been mildly problematic in the past

Gastric acid and digestive enzymes degrade most peptides before absorption can occur