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Article

Denosumab-induced Hypocalcemia in Patients with Osteoporosis and Normal Renal Function

Zouheir Ibrahim Bitar1★, Adnan M A Hajjiah2, Ossama Sajeh Maadarani1, Mahmoud Mostafa Elzoueiry3, Mohamed Refaat Gohar4, Mohamad Abdelfatah5, Fawaz Alabdali6★ Corresponding author

  1. 1Department of Internal Medicine, Critical Care Unit, Ahmadi Hospital, Kuwait Oil Company, Fahaheel, KUWAIT.
  2. 2Department Pharmacy, Senior Clinical Pharmacist, Ahmadi Hospital, Kuwait Oil Company, Fahaheel, KUWAIT.
  3. 3Department of Internal Medicine, Ahmadi Hospital, Kuwait Oil Company, Fahaheel, KUWAIT.
  4. 4Department of Internal Medicine, Specialist Internal Medicine, Ahmadi Hospital, Kuwait Oil Company, Fahaheel, KUWAIT.
  5. 5Department of Internal Medicine, Specialist Critical Care Medicine, Ahmadi Hospital, Kuwait Oil Company, Fahaheel, KUWAIT.
  6. 6Department of Internal Medicine, Head of Endocrinology and Diabetic Unit, Ahmadi Hospital, Kuwait Oil Company, Fahaheel, KUWAIT.

CORRESPONDENCE

Zouheir Ibrahim Bitar

Department of Internal Medicine, Critical Care Unit, Ahmadi Hospital, Kuwait Oil Company, Fahaheel, KUWAIT.

zbitar2@hotmail.com

Received: 10-03-2023; Revised: 28-04-2023; Accepted: 26-05-2023.

Volume 13, Issue 4 · pp. 789–792 · PUBLISHED · DOI: 10.5530/ijpi.13.4.098

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ABSTRACT

Introduction: The reported hypocalcemia was low in denosumab-treated postmenopausal women with osteoporosis (0.05–1.7% to 7.4%). The major prediction factors were Vitamin D and calcium levels and renal function. Aim:To assess the rate of hypocalcemia in patients with osteoporosis treated with denosumab, with normal renal function and Vitamin D. Materials and Methods: A retrospective analysis was conducted using the medical records (2021–2022). We looked for hypocalcemia (albumin-adjusted calcium lower than 2.1 mmol/L). Results: We included 201 women with postmenopausal osteoporosis who received denosumab treatment plus prophylactic Vitamin D3 capsules. The mean age of the patient population was 75.7 ± 7.0 years (56–91 years). Hypocalcemia was observed in 46 (23%) patients following a single subcutaneous dose of denosumab 60 mg. Median calcium was 2.25 mmol/L (minimum: 0.890 mmol/L, maximum: 2.6 mmol/L). Fourteen (30.4%) patients had severe cases (< 1.8 mmol/L) and required parenteral correction. A comparison between hypocalcemia and patients with normal calcium indicated that the strongest predictors of hypocalcemia were pretreatment parathyroid hormone levels (9.9 ± 0.5 vs. 7.6 ± 0.5 pg/L, respectively; p<0.005). Eight patients (3.3%) developed hypophosphatemia. The baseline serum albumin, calcium, and alkaline phosphatase levels were normal. Conclusion: The denosumab-associated hypocalcemia is more prevalent than previously shown in patients with osteoporosis receiving adequate calcium and Vitamin D supplementation. An elevated parathyroid hormone is an important predicting factor in patients with normal calcium and Vitamin D levels.

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    Bitar, Z. I., Hajjiah, A. M. A., Maadarani, O. S., Elzoueiry, M. M., Gohar, M. R., Abdelfatah, M., & Alabdali, F. (). Denosumab-induced Hypocalcemia in Patients with Osteoporosis and Normal Renal Function. International Journal of Pharmaceutical Investigation, 13(4), 789–792. https://doi.org/10.5530/ijpi.13.4.098