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Case Reports
. 2020 Aug 26;13(8):e234508.
doi: 10.1136/bcr-2020-234508.

Denosumab-induced severe hypocalcaemia in a patient with vitamin D deficiency

Natasha Daga  1 , Flavian Joseph  2
Affiliations
Case Reports

Denosumab-induced severe hypocalcaemia in a patient with vitamin D deficiency

Natasha Daga et al. BMJ Case Rep. .

Corrected and republished in

Abstract

Postmenopausal women are at increased risk of osteoporosis. Osteoporotic fractures carry an increased risk of morbidity and mortality. Denosumab is a monoclonal antibody widely used for the treatment of osteoporosis by inhibiting osteoclast-induced bone resorption. Hypocalcaemia is a known side-effect of denosumab treatment. The majority of such cases have been described in patients with underlying metastatic cancer or chronic kidney disease. We present a patient who developed severe hypocalcaemia after administration of denosumab in the context of severe vitamin D deficiency and a normal kidney function. The management was further complicated by hypophosphatemia. Following replacement of vitamin D, the patient's calcium and phosphate levels stabilised. The patient required intensive care monitoring for replacement of electrolytes. This case report emphasises the importance of screening and ongoing monitoring of risk factors for iatrogenic hypocalcaemia with denosumab treatment.

Keywords: calcium and bone; drugs: endocrine system; endocrine system.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Calcium, phosphate and vitamin D metabolism.
Figure 2
Figure 2
ECG on admission demonstrating prolonged QTc (535 ms).
Figure 3
Figure 3
Trends in calcium and phosphate levels during admission. The patient was on oral calcium (1200 mg two times per day) and calcitriol (0.25 µg two times per day) and oral phosphate (1000 mg two times per day) in addition to requiring intravenous replacement during this time.
See this image and copyright information in PMC

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