Immobilization hypercalcemia treatment with pamidronate disodium after spinal cord injury

Abstract

Objective: To review the use of pamidronate to treat immobilization hypercalcemia after acute spinal cord injury (SCI) in 9 cases.

Design: Retrospective case series.

Setting: Two inpatient rehabilitation programs, one pediatric and one adult, in the Northwest Regional Spinal Cord Injury System.

Patients: Patients with acute SCI who developed immobilization hypercalcemia that was treated with pamidronate.

Results: Nine patients (7 men, 2 women), ages 15 to 41 yrs, with SCI (8 tetraplegia, 1 paraplegia) were treated using pamidronate between 1994 and 1998. A single dose of 60 mg of pamidronate resolved the hypercalcemia or its symptoms in 7 (78%) patients within days. One patient required a second dose (90 mg) and one patient required three additional doses (the fourth at 90 mg) to achieve resolution of the hypercalcemia or symptoms. Side effects were mild and included drug-related fever in one patient and transient asymptomatic hypocalcemia in four patients.

Conclusion: Pamidronate was effective in treating immobilization hypercalcemia caused by SCI. Its advantages include its effectiveness, the duration of treatment, ease of administration, and elimination of the need for long-term intravenous saline or daily medications.