Elevated parathyroid hormone levels in older women treated for osteoporosis using denosumab

Ogunwale, Abayomi N; Hameed, Fariha; Valdez, Luis; Bordes, Jude des; Jamil, Maryam; Rianon, Nahid J

doi:10.1007/s41999-021-00567-4

Cited by 3 publications

(2 citation statements)

References 14 publications

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“…In normocalcemic secondary Hyperparathyroidism (HPT), PTH secretion increases as a reflex to a low calcium stimulus. 5,6 The evaluation of patients who may receive denosumab is the same as recommended for all patients with osteoporosis, e.g., complete blood count, complete chemistry profile (including alkaline phosphatase), calcium, phosphorus, and 25-hydroxyvitamin D. 7 Physicians tend not to check the parathyroid hormone levels in patients with normal serum calcium levels. Therefore, correcting hypocalcemia and hypovitaminosis D before starting denosumab therapy is essential.…”

Section: Discussionmentioning

confidence: 99%

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

Bitar,

Hajjiah,

Maadarani

et al. 2023

Int J. Pharm. Investigation

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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 D 3 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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Section: Discussionmentioning

confidence: 99%

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

Bitar,

Hajjiah,

Maadarani

et al. 2023

Int J. Pharm. Investigation

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“…In addition, the results herein suggested that infants with abnormal bone density were significantly higher than infants in normal infants, and serum ALP and PTH were negatively correlated with serum 25(OH)D levels. PTH can also stimulate bone formation, thereby increasing bone density and improving the microstructure in osteoporosis (27,28). It was suggested that infants and infants of abnormal bone density were provided with early VD supplementation to upregulate 25(OH)D, and to maintain calcium, phosphorus, ALP, and PTH levels in infants and infants.…”

Section: Discussionmentioning

confidence: 99%

Monitoring of serum 25-(OH)D level in infants and its correlation with bone density and development

Dan Ming,

Rongxiu Zheng

2023

Cell Mol Biol (Noisy-le-grand)

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Hypocalcemia in Patients With Osteoporosis and Normal Renal Function, Treated With Denosumab, a Retrospective Analysis

Bitar,

Hajjiah,

Maadarani

et al. 2024

Nutr Metab Insights

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Objective: The reported hypocalcemia in postmenopausal women with osteoporosis who received Denosumab was low (0.05%-1.7% to 7.4%). The major prediction factors were vitamin D and calcium levels and renal function. The objective is to evaluate the incidence of hypocalcemia in patients with osteoporosis, normal renal function, and vitamin D who received Denosumab. Method: A retrospective analysis was conducted using the medical records (2022-2023). We looked for hypocalcemia (albumin-adjusted calcium lower than 2.2 mmol/L). Results: Two hundred one postmenopausal women diagnosed with osteoporosis and received denosumab treatment were included. All patients received vitamin D3 capsules and calcium supplementation. The mean age of the patient was 75.7 ± 7.0 years (56-91 years). Hypocalcemia was observed in 46 (23%) patients following a 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 hypocalcemia (<1.8 mmol/L) and required parenteral correction. A comparison between hypocalcemia and patients with normal calcium indicated that the significant predictor of hypocalcemia was pretreatment parathyroid hormone levels (9.9 ± 11.8vs 7.6 ± 2.56 pmol/L, respectively; P < .005). The prognostic role of parathyroid hormone for the denosumab-associated hypocalcemia was assessed using ROC curve analysis. For the cut-off value of Parathyroid hormone = 6.8 pmol/L, giving serum parathyroid measurement an AUC of 0.668 (0.599-0.737) - P = .0007; sensitivity 85%; specificity 52%. Conclusion: Hypocalcemia induced by the denosumab treatment is more prevalent than previously shown in patients with osteoporosis receiving adequate calcium and vitamin D supplements. An elevated parathyroid hormone predicts hypocalcemia related to denosumab therapy in patients with normal calcium and vitamin D levels.

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Elevated parathyroid hormone levels in older women treated for osteoporosis using denosumab

Cited by 3 publications

References 14 publications

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

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

Monitoring of serum 25-(OH)D level in infants and its correlation with bone density and development

Hypocalcemia in Patients With Osteoporosis and Normal Renal Function, Treated With Denosumab, a Retrospective Analysis

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