Hypercalcaemia and hypocalcaemia: finding the balance

Abstract

Calcium metabolism in cancer and hypercalcaemia of malignancyThe balance between bone formation and resorption may be disrupted in patients with cancer, leading either to increased bone resorption, calcium release, and possibly hypercalcaemia, or to increased bone formation, sequestration of calcium, and possibly hypocalcaemia. In adults, hypercalcaemia of malignancy is most common in patients with tumours that produce factors that induce osteoclast activation and enhance bone resorption. Impaired renal function and increased renal tubular calcium resorption may further affect calcium levels.Treatment of hypercalcaemia of malignancyInhibitors of bone resorption, first the bisphosphonates and, later, denosumab, have been shown to be effective in hypercalcaemia treatment. Bisphosphonates (which are administered intravenously) are approved for hypercalcaemia of malignancy and are the current mainstay of treatment, whereas denosumab (which is administered subcutaneously) may offer an option for patients who do not respond to bisphosphonates or suffer from renal insufficiency.Hypocalcaemia: treatment and preventionHypocalcaemia is most common in patients with prostate cancer and osteoblastic bone metastases, but can occur in patients with a variety of tumour types who are receiving inhibitors of bone resorption. While patients often respond to calcium and vitamin D supplementation, prevention should be the aim; at-risk patients should be identified before starting treatment with inhibitors of bone resorption, be closely monitored during at least the first few months of treatment, and receive concomitant calcium and vitamin D supplementation unless hypercalcaemia is present.ConclusionBoth hypercalcaemia and hypocalcaemia can be serious if left untreated. It is therefore important that patients with cancer are closely monitored and receive adequate prevention and treatment measures to maintain normal blood calcium levels.

Clinical Assessment and Management of Delirium in the Palliative Care Setting

“…In this study, denosumab was found to lower serum calcium levels in 21 of 33 (64%) patients within 10 days [ 77 ]. Due to an increased risk of hypocalcemia with denosumab, patients should be monitored post-treatment as they may require calcium and vitamin D supplementation [ 78 ]. Results from larger studies with longer-term evaluation after denosumab treatment are needed.…”

Systematic Review of the Long-Term Effects of Transgender Hormone Therapy on Bone Markers and Bone Mineral Density and Their Potential Effects in Implant Therapy

“…In the presence of metabolic imbalances produced by the cross-sex pharmacologic therapies, the blood calcium balance system can be altered, thereby playing an important role as an ethiological factor for pharmacologically induced osteoporosis [48].…”

Treatment of malignancy-associated hypercalcemia with cinacalcet: a paradigm shift

“…Hypercalcemia can develop when the predominant force is osteoclastic, and hypocalcemia can develop due to calcium sequestration when the driving force is osteoblastic. Although cancers can exhibit predominantly increased resorption or formation of bone, a mixed picture is not uncommonly observed (33,34,35). Increased resorption and impaired formation are driven by local factors and humoral tumor factors produced by the tumor.…”