Prolonged Hypocalcemia After Treatment With Zoledronic Acid in a Patient With Prostate Cancer and Vitamin D Deficiency

Breen, Tracy L.; Shane, Elizabeth

doi:10.1200/jco.2004.99.013

Cited by 50 publications

(29 citation statements)

References 13 publications

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“…The risk factors reported in literature that can contribute to symptomatic hypocalcemia with denosumab or zoledronic acid include: chronic kidney disease, vitamin D deficiency, hypomagnesemia, hypophosphatemia, and glucocorticoid use [10][11][12][13]. However, the small patient cohort and very low incidence of hypocalcemia in our study population limits the identification of risk factors.…”

Section: Discussionmentioning

confidence: 47%

Incidence of Hypocalcemia in Patients with Post-Menopausal Osteoporosis or Cancer Skeletal Related Events after Denosumab in Comparison to Zoledronic Acid in a Community Hospital Setting

Newman¹

2015

J Pharmacovigil

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Section: Discussionmentioning

confidence: 47%

Incidence of Hypocalcemia in Patients with Post-Menopausal Osteoporosis or Cancer Skeletal Related Events after Denosumab in Comparison to Zoledronic Acid in a Community Hospital Setting

Newman¹

2015

J Pharmacovigil

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“…Hypocalcemia following bisphosphonate therapy has been reported in patients with Paget's disease of bone [Papapetrou, 2009;Polyzos et al 2011;Reid et al 2005], juvenile Paget's disease of bone [Polyzos et al 2010], osteoporosis [Black et al 2007;Lyles et al 2007;Reid et al 2002;Tsourdi et al 2011], malignancies with metastatic bone disease and multiple myeloma [Mehrotra, 2009;Segal et al 2012], osteogenesis imperfecta [Vuorimies et al 2011], and in patients with bone loss following liver transplantation [Crawford et al 2006]. In many instances, patients have had comorbid conditions which can increase the risk of hypocalcemia including pre-existing hypoparathyroidism, hypomagnesaemia, renal insufficiency, vitamin D deficiency or insufficiency, gastrointestinal malabsorption, and repeated bisphosphonate infusions in patients with malignancy [Breen and Shane, 2004;Chennuru et al 2008;Peter et al 2004;Polyzos et al 2011;Rosen and Brown, 2003]. In a number of reports, suboptimal calcium intake and/or vitamin D supplementation appear to have been important underlying risk factors [Breen and Shane, 2004;Polyzos et al 2011;Segal et al 2012;Whitson et al 2006].…”

Section: Discussionmentioning

confidence: 99%

“…In some cases, there have been reports of symptomatic, severe and persistent hypocalcemia, especially in patients treated with intravenous (IV) aminobisphosphonates such as pamidronate and zoledronic acid [Fenton et al 1991;Ferraz-de-Souza et al 2013;Gutteridge et al 1996;Papapetrou, 2009;Polyzos et al 2011;Ralston, 2013]. A review of the available data also suggests that subnormal serum calcium levels were observed following treatment with bisphosphonates in patients with metastatic bone disease and multiple myeloma [Breen and Shane, 2004;Mehrotra, 2009;Segal et al 2012], osteoporosis [Black et al 2007;Lyles et al 2007;Reid et al 2002;Tsourdi et al 2011], osteogenesis imperfecta [Vuorimies et al 2011], renal insufficiency [Polyzos et al 2011], malignancies [Chennuru et al 2008;Major and Coleman, 2001;Sims et al 1998], underlying vitamin D deficiency or insufficiency [Breen and Shane, 2004;Ralston, 2013;Rosen and Brown, 2003;Segal et al 2012] and poor calcium intake and/or calcium malabsorption [Breen and Shane, 2004].…”

Section: Introductionmentioning

confidence: 99%

Effect of zoledronic acid on serum calcium in Paget’s disease patients after educational strategies to improve calcium and vitamin D supplementation

Tucci

Bone²,

et al. 2015

Therapeutic Advances in Endocrinology

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Objective: Bisphosphonates are the most effective therapeutic agents in patients with Paget's disease of bone. As a result of their inhibition of osteoclastic activity, hypocalcemia of variable frequency and severity following intravenous bisphosphonate therapy has been reported. The present study assessed the effect of physician and patient education on adequate supplementation of calcium and vitamin D to reduce the potential risk of developing hypocalcemia following infusion of 5 mg zoledronic acid. Methods:This was an open-label, multicenter, controlled registry trial in which patients with Paget's disease were treated with a single intravenous infusion of zoledronic acid. Physicians were provided with educational materials focusing on optimization of calcium and vitamin D supplementation following zoledronic infusion that they used to educate their patients. The primary safety variable was the percentage of patients with serum calcium level <2.07mmol/l 9-11 days after zoledronic acid infusion. Results: A total of 75 patients were evaluable in the post dose hypocalcemia safety analysis. Of these, only 1 patient had treatment-emergent hypocalcemia, with a serum calcium level of 1.92 mmol/l 4 days following therapy. Hypocalcemia-related symptoms were not reported in this patient and the serum calcium returned to normal range at 2.17 mmol/l within 1 week on oral calcium supplementation. Conclusions: These results suggest that, with optimization of calcium and vitamin D supplementation by physician and patient education, hypocalcemia is an infrequent occurrence following zoledronic acid infusion.

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“…[5][6][7] Other risk factors for hypocalcemia by intravenous bisphosphonate were hypoparathyroidism (i.e. due to previous thyroid surgery or radiation to the neck) and hypomagnesemia.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, there are some anecdotal reports of patients with solid tumor or osteoporosis developing symptomatic hypocalcemia following intravenous administration of ZDA. [5][6][7] In these studies, impaired renal function and vitamin D deficiency were cited as main risk factors for development of symptomatic hypocalcemia. Subsequently, however, a study examining the risk factors for symptomatic hypocalcemia associated with ZDA treatment revealed that symptomatic hypocalcemia developed despite appropriate dose adjustment for creatinine clearance.…”

mentioning

confidence: 99%

Risk Factors Contributing to the Development of Hypocalcemia after Zoledronic Acid Administration in Patients with Bone Metastases of Solid Tumor

Hanamura

Iwamoto

Soga

et al. 2010

Biological & Pharmaceutical Bulletin

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Bisphosphonates are commonly used to treat hypercalcemia and to prevent skeletal complications in patients with multiple myeloma or bone metastases from cancers of the prostate, breast and lung.1,2) Zoledronic acid (ZDA) is one of the most potent bisphosphonates, and is about 850-fold more potent than pamidronate.3) Intravenous administration of ZDA (4 mg) was shown to be significantly more effective than pamidronate (90 mg) for reducing the risk of skeletal complications, based on multiple event analysis in a large comparative trial of these two agents in patients with multiple myeloma or breast cancer. 4) Since discontinuation or a prolonged ZDA treatment interval may adversely affect the treatment and prevention of skeletal-related events or refractory bone pain, administration of ZDA according to an optimal schedule is considered to be important.ZDA inhibits the breakdown of bone (resorption) by inducing apoptosis of osteoclasts, resulting in decreased release of calcium into the bloodstream. With this mechanism of action, mild biochemical hypocalcemia is common after administration of ZDA, and its occurrence rate was reported to be the second most common event after fever in a postmarketing surveillance study in Japan. In addition, there are some anecdotal reports of patients with solid tumor or osteoporosis developing symptomatic hypocalcemia following intravenous administration of ZDA. [5][6][7] In these studies, impaired renal function and vitamin D deficiency were cited as main risk factors for development of symptomatic hypocalcemia. Subsequently, however, a study examining the risk factors for symptomatic hypocalcemia associated with ZDA treatment revealed that symptomatic hypocalcemia developed despite appropriate dose adjustment for creatinine clearance.8) Therefore, there is a need to investigate the risk factors for ZDA-induced hypocalcemia other than renal impairment.In this study, we reviewed the records of patients receiving ZDA in Mie University Hospital over a three year period to assess the risk factors for ZDA-induced hypocalcemia. PATIENTS AND METHODS PatientsThis was a retrospective chart review assessing risk of hypocalcemia after ZDA administration. The two pharmacists in the study group reviewed the medical records (physician, nurse and pharmacist records) of 174 patients who received initial intravenous administration of 4 mg ZDA to treat solid tumor bone metastases from August 2006 to November 2009 at Mie University Hospital. Patients were excluded if there were some evidences of receiving following prescription drugs and OTC drugs: calcium salt, activated vitamin D 3 , estrogen, vitamin K 2 , calcitonin, aminoglycoside antibiotics, cinacalcet hydrochloride or thalidomide, which can influence serum calcium concentrations in the medical record. In addition, patients were excluded if they had a medical history of parathyroid disorder or hypercalcemia (adjusted serum calcium concentration Ͼ10.5) before ZDA administration. Total of 49 patients (24 prostate cancer, 8 lung cancer, 6 renal ...

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Prolonged Hypocalcemia After Treatment With Zoledronic Acid in a Patient With Prostate Cancer and Vitamin D Deficiency

Cited by 50 publications

References 13 publications

Incidence of Hypocalcemia in Patients with Post-Menopausal Osteoporosis or Cancer Skeletal Related Events after Denosumab in Comparison to Zoledronic Acid in a Community Hospital Setting

Incidence of Hypocalcemia in Patients with Post-Menopausal Osteoporosis or Cancer Skeletal Related Events after Denosumab in Comparison to Zoledronic Acid in a Community Hospital Setting

Effect of zoledronic acid on serum calcium in Paget’s disease patients after educational strategies to improve calcium and vitamin D supplementation

Risk Factors Contributing to the Development of Hypocalcemia after Zoledronic Acid Administration in Patients with Bone Metastases of Solid Tumor

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