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Case Reports
. 2018 Oct 8:13:1929-1934.
doi: 10.2147/CIA.S180614. eCollection 2018.

High bone turnover status as a risk factor in symptomatic hypocalcemia following denosumab treatment in a male patient with osteoporosis

Koji Ishikawa  1   2   3 , Takashi Nagai  1 , Koki Tsuchiya  1 , Yusuke Oshita  3 , Takuma Kuroda  1 , Hiroshi Ito  1 , Soji Tani  1 , Yusuke Dodo  1 , Tomoaki Toyone  1 , Katsunori Inagaki  1
Affiliations
Case Reports

High bone turnover status as a risk factor in symptomatic hypocalcemia following denosumab treatment in a male patient with osteoporosis

Koji Ishikawa et al. Clin Interv Aging. .

Abstract

Denosumab is a fully human monoclonal antibody against the receptor activator of nuclear factor-κB ligand (RANKL) that is used for the treatment of osteoporosis. Denosumab-induced hypocalcemia is a rare but important adverse event, which is usually asymptomatic in patients with osteoporosis. It is also known that hypocalcemia is common in patients with bone metastases and severe renal impairment. Here we report a case of symptomatic hypocalcemia following administration of 60 mg of denosumab in a patient with high bone turnover and no renal impairment (estimated glomerular filtration rate [eGFR], 71 mL/min), despite prophylactic oral vitamin D administration. This report supports our observation that there is a risk of protracted and marked denosumab-induced hypocalcemia in patients with high bone turnover, irrespective of their degree of renal impairment.

Keywords: denosumab; high bone turnover; no renal impairment; symptomatic hypocalcemia.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Plain lateral radiographs and MRI demonstrated a fresh vertebral fracture at L3 and T12. Abbreviations: L, lumbar; T, thoracic.
Figure 2
Figure 2
Serum calcium and intact PTH levels. Notes: After the serum calcium was normalized, it did not change significantly over the three courses of denosumab. PTH continued to be elevated 2 weeks following denosumab administration. Subsequently, PTH was normalized owing to calcium supplementation. Abbreviations: M, month; Ca, calcium; PTH, parathyroid hormone.
Figure 3
Figure 3
Bone turnover markers (TRACP-5b, total-P1NP) and eGFR levels. Notes: TRACP-5b and total-P1NP levels decreased immediately following the first course of denosumab treatment. Renal function diminished mildly over the entire course of treatment. Abbreviations: M, month; TRACP-5b, tartrate-resistant acid phosphatase type 5; total-P1NP, total N-terminal propeptide of type 1 procollagen; eGFR, estimated glomerular filtration rate.
Figure 4
Figure 4
1,25(OH)2D and 25(OH)D levels. Notes: 1,25(OH)2D was suppressed following eldecalcitol supplementation. 25(OH)D level is higher in summer and autumn and lower in winter. Abbreviations: M, month; 1,25(OH)2D, 1,25-dihydroxyvitamin D; 25(OH)D, 25-hydroxyvitamin.
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