Giant cell tumors (GCTs) are aggressive benign lesions that occur in the bone epiphysis. They are most often found in the long bones of the lower extremities. Wrist bone involvement is rare, capitate bone involvement exceedingly rare. Treatment in the wrist usually consists of excision, local adjuvant treatment, and cementing and/or bone grafting. GCTs also metastasize to the lungs; pulmonary lesions are excised and systemic therapy provided. We present the case of a 19-year-old woman with GCT of the capitate bone. After initial excision and cementing, the GCT recurred with lung metastases during a pregnancy. Rapid expansion of the GCT during pregnancy was reversed with systemic treatment with denosumab after pregnancy. Excellent response to this chemotherapy permitted limb-sparing surgery and wrist reconstruction with structural cortical autogenous bone graft. Resection of pulmonary metastases after a year of treatment with denosumab revealed lung parenchyma with calcification and ossification and limited viable tumor.