Objective: Denosumab is a monoclonal antibody commonly used for the prevention of skeletal-related events in patients with bone metastases from solid tumors. Hypocalcemia is a known adverse effect with denosumab, and we present an unusual case where 2 hypocalcemic events occurred after 1 denosumab treatment.
Methods: A 76-year-old man recently diagnosed with prostate cancer with bone metastasis was given 120 mg denosumab subcutaneously due to extensive bone disease.
Results: The patient experienced denosumab-induced hypocalcemia induced by a single denosumab dose which was resolved after 14 days of multiple doses of intravenous calcium gluconate and oral calcium and vitamin D replacement. However, the patient returned with acute kidney injury and severe hypocalcemia (corrected calcium of 6.9 mg/dL) without any additional dose of denosumab. The recovery following the second episode of hypocalcemia was much longer than the initial episode in this patient.
Conclusion: To our knowledge, this is the first reported case of an additional episode of hypocalcemia following a single denosumab dose. This case highlights the importance of close monitoring of renal function and serum electrolytes following the resolution of denosumab-induced hypocalcemia.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6876976 | PMC |
| http://dx.doi.org/10.4158/ACCR-2018-0295 | DOI Listing |
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Article Synopsis
- - The study investigated whether the combination of denosumab (used for osteoporosis) and loop diuretics, which increase calcium excretion in urine, leads to hypocalcaemia (low calcium levels) in patients.
- - An analysis of adverse drug event reports indicated a significant association between loop diuretics and an increased risk of hypocalcaemia in patients taking denosumab, with a reporting odds ratio suggesting a strong correlation.
- - It was found that higher baseline calcium levels and calcium/vitamin D supplementation could lower the risk of hypocalcaemia, while the effect of denosumab on calcium levels was more pronounced when combined with loop diuretics.
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