ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2020
Denosumab-induced hypocalcemia in patients with osteoporosis: can you know who will get low?
Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 1 of them a synthesis that pooled it.
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31 citing papers in PubMed, 1 synthesis or guideline pooled it, 66 citations in OpenAlex.
- Additional effects of herbal medicine combined with bisphosphonates for primary osteoporosis: a systematic review and meta-analysis.Frontiers in pharmacology · 2024Pooled it
- Hypocalcemia following denosumab in osteoporosis: Incidence and risk factors in a Saudi cohort.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Severe Prolonged Hypocalcemia After Denosumab Administration in a Patient With Sleeve Gastrectomy: A Case Report.Cureus · 2026Article
- Multidisciplinary approach and clinical management of McCune-Albright syndrome.Frontiers in endocrinology · 2026Review
- [Changes in circulating levels of calcium and bone metabolism biochemical markers in patients receiving denosumab treatment].Nan fang yi ke da xue xue bao = Journal of Southern Medical University · 2025Article
- Bone turnover markers as predictors of hypocalcemia in patients with bone metastases receiving denosumab.JBMR plus · 2025Article
- Beyond Bone Remodeling: Denosumab's Multisystemic Benefits in Musculoskeletal Health, Metabolism, and Age-Related Diseases-A Narrative Review.Biomedicines · 2025Review
- Long-Term Efficacy and Safety of Denosumab: Insights beyond 10 Years of Use.Endocrinology and metabolism (Seoul, Korea) · 2025Review
- Asymptomatic Hypocalcemia Related to Denosumab Administration in Bone-Metastatic Patient Affected by Colorectal Cancer: A Case Report.Endocrine, metabolic & immune disorders drug targets · 2025Article
- Severe hypophosphataemia and hypocalcaemia following intravenous ferric derisomaltose and denosumab administration.BMJ case reports · 2024Article
- Influence of loop diuretics on denosumab-induced hypocalcaemia in osteoporosis: a retrospective observational analysis.Journal of pharmaceutical health care and sciences · 2024Article
- Safety of In-hospital Parenteral Antiosteoporosis Therapy Following a Hip Fracture: A Retrospective Cohort.Journal of the Endocrine Society · 2024Article
- External Validation and Update of the Risk Prediction Model for Denosumab-Induced Hypocalcemia Developed From a Hospital-Based Administrative Database.JCO clinical cancer informatics · 2024Article
- Risk factors for nonresponse to 2 years of denosumab administration in patients with osteoporosis: A retrospective single-center cohorts study.Health science reports · 2024Article
- Hypocalcemia in Patients With Osteoporosis and Normal Renal Function, Treated With Denosumab, a Retrospective Analysis.Nutrition and metabolic insights · 2024Article
- Prevalence of denosumab-induced hypocalcemia: a retrospective observational study of patients routinely monitored with ionized calcium post-injection.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2024Observational
- Post hip fracture orthogeriatric care-a Canadian position paper addressing challenges in care and strategies to meet quality indicators.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2023Review
- Severe Refractory Hypocalcemia Caused by Denosumab.Cureus · 2023Article
- Denosumab-induced hypocalcemia post bariatric surgery-a severe and protracted course: a case report.Journal of medical case reports · 2023Article
- Pharmacological Interventions Targeting Pain in Fibrous Dysplasia/McCune-Albright Syndrome.International journal of molecular sciences · 2023Review
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6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Hypocalcemia was reported at low rates (0.05-1.7%) in denosumab-treated postmenopausal women with osteoporosis. This real-life study shows a 7.4% rate of denosumab-induced hypocalcemia in community-dwelling osteoporotic men and women. Pretreatment serum calcium and creatinine levels are major predictors for this complication. Serum-calcium monitoring may help to identify and prevent severe hypocalcemia. PURPOSE: RCTs have reported a 0.05-1.7% rate of hypocalcemia in denosumab-treated postmenopausal women with osteoporosis, but long-term real-life data are lacking. We assessed the rate of hypocalcemia in osteoporotic community-dwelling patients treated with denosumab.
methodsA retrospective analysis was conducted based on medical records (2010-2018) from a large HMO. An albumin-adjusted serum calcium concentration lower than 8.5 mg/dL was defined as hypocalcemia.
resultsWe included 2005 patients (93% women, mean age 76 ± 9 years). Hypocalcemia developed during treatment in 149 patients (7.4%; 1% less than 8 mg/dL): in 66 after 0.5-1 years; 48 after 1-2 years; 35 after > 2 years. On comparison of the hypocalcemic and normocalcemic patients, the strongest predictors of hypocalcemia were pretreatment levels of albumin-adjusted serum calcium (9.1 ± 0.4 vs. 9.4 ± 0.5 mg/dL, respectively; p < 0.05) and creatinine (0.9 ± 0.5 vs. 0.8 ± 0.3 mg/dL, respectively; p < 0.05). The hypocalcemia rate increased in parallel to a decrease in eGFR (p = 0.032 for the difference between eGFR ranges). Baseline calcium level ≤ 9.31 mg/dL predicted hypocalcemia with a sensitivity of 77% and specificity of 56%. A model of (- 2)*calcium + creatinine predicted hypocalcemia (3.7% when lower and 17.1% when higher than - 17.4). Gender, age, 25-hydroxyvitamin-D, parathyroid hormone, alkaline phosphatase, and whether denosumab was given as first or advanced line of osteoporotic therapy had no predictive value.
conclusionReal-life rates of denosumab-induced hypocalcemia are higher than previously reported. Hypocalcemia might develop after each dose of denosumab in ongoing treatment. Adequate calcium and vitamin D supplementation are needed. Serum calcium monitoring is advised in high-risk patients for early detection of severe hypocalcemia.
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