Introduction
Case report
Date | cCa (mmol/l) | PTH (pmol/l) | Creatinine (μmol/l) | CTX (ng/l)/PNP1 (μg/l) | 25-OH vit D (nmol/l) | Intervention |
---|---|---|---|---|---|---|
30.05.2013 | (iCa: 1.43; N 1.15–1.29) | 44 | Denosumab introduction | |||
10.2016 | Denosumab injection | |||||
07.04.2017 | 2.82 | 24.2* | 77 | 77 | 6 months after denosumab | |
05.2017 | Cinacalcet 30 mg initiation | |||||
30.05.2017 | 2.51 | Cinacalcet reduction to 15 mg | ||||
13.07.2017 | 3.53 | Cinacalcet had been discontinued by patient, reintroduction at 30 mg | ||||
18.07.2017 | 3.11 | 10 | ||||
29.07.2017 | 3.35 | 69 | 162 | Hospitalization (calcitonin, i.v. hydration, and cinacalcet 30 mg) | ||
03.08.2017 | 2.57 | Under whole treatment | ||||
07.08.2017 | 2.99 | 6.5* | Under cinacalcet | |||
18.08.2017 | 3.11 | Under cinacalcet | ||||
21.08.2017 | 3.06 | 9.2* | 111 | 1777/156 | Denosumab injection | |
14.09.2017 | 2.79 | 20.9* | 93 | 122/114 | ||
13.10.2017 | 2.58 | 31.7 | 65 | |||
14.11.2017 | 2.61 | 34.4 | ||||
20.12.2017 | 2.62 | 81 | ||||
08.02.2018 | 2.76 | 20.5# | Denosumab injection | |||
20.09.2018 | 2.77 | 16.8# | 367/30 | 96 | Denosumab injection | |
18.10.2018 | 2.63 | |||||
18.01.2019 | 2.69 | 71 | 40/14 | |||
20.02.2019 | 2.76 | 28.7# | 30/13 | 76.7 | Parathyroidectomy | |
21.02.2019 | 2.44 | 7.5# | Immediate post-surgery | |||
26.02.2019 | 2.17 | 18.3* | 40/9 | |||
18.03.2019 | 2.36 | 4.45# | 87 | 27 / 18 | Denosumab injection | |
11.04.2019 | 2.38 |
Discussion
Number of pat | Reference | Age, sex | Indication | DMAb dose, frequency, duration | Reason for discontinuation | Delay to hypercalcemia diagnosis | Ca/P values | BTMs, PTH, FGF23 | Clinical consequences | Hypercalcemia treatment |
---|---|---|---|---|---|---|---|---|---|---|
1 | Boyce et al.; J Bone Miner Res.2012;27:1462 [8] | 9 years, M | Fibrous dysplasia, expanding lesion | 0.9 mg/kg, 1×/month, 7 doses | Femoral fracture, theoretical risk of delayed fracture healing | 2 months | 4.5 mmol/l; P normal | P1NP > 1000 μg/l, CTX ≥ 5000 ng/l, PTH suppressed | 5 days vomiting | Rehydration, repeated bisphosphonate (pamidronate), calcitonin |
1 | Grasemann et al.; J Clin Endocrinol Metab.2013; 98:3121 [9] | 8 years, F | Juvenile Paget’s disease | 0.5 mg/kg, 1×/6 weeks, 2 doses | Improvement clinical condition | 7 weeks | Ca 4.07 mmol/l | Polyuria, nausea, constipation | Bisphosphonate (pamidronate) | |
1 | Gossai et al.; Pediatr Blood Cancer.2015; 62:1078 [5] | 10 years, F | Metastatic giant cell tumor of bone | 120 mg, 4×/month, then 1×/month, 24 months (28 doses) | Decrease in tumor size and improved pain; risk of osteopetrosis | 5 m | Ca 4.15 mmol/l; P normal | PTH suppressed | Nausea, vomiting, acute kidney injury | Aggressive hydration, calcitonin, bisphosphonate (pamidronate), corticosteroids, restart DMAb |
1 | Setsu et al.; J Bone Miner Metab.2016; 34:118 [6] | 10 years, M | Unresectable giant cell tumor of bone | 120 mg, 1×/month, 14 months (12 doses) | Development of sclerotic changes in the growth plates | 4 months | tCa 3.8 mmol/l; iCa 1.68 mmol/l; P 0.77 mmol/l | PTH suppressed (0.2 pmol/l) # | Nausea, fatigue, alkalosis, renal dysfunction, dehydration, sinus bradycardia with normal QTc | Saline hydration, furosemide, corticosteroid, calcitonin, bisphosphonate (zoledronate, 2×) |
10 | Hoyer-Kuhn et al.; J Musculosckelet Neuronal Interact.2016; 16:24 [3] | 5–11 years, 7 M and 3 F | Osteogenesis imperfecta | 1 mg/kg, 1×/3 months, 1 years | Primary endpoint of the study | Not specified | iCa 1.4 mmol/l | Osteocalcin and PTH detectable | No clinical significance | |
1 | Koldkjær Sølling et al.; Osteoporos Int.2016; 27:2383 [4] | 67 years, F | Osteoporosis | 60 mg, 1×/6 months, 10 years | End of clinical trial (FREEDOM) | 6 months | tCa 3.1 mmol/l; iCa 1.64 mmol/l; P 0.94 mmol/l | PTH suppressed (1.6 pmol/l) | No symptoms | Calcium-vit D substitution discontinuation; hyperhydration |
1 | Boyce; Curr Osteoporos Rep.2017; 15:283 [10] | 23 months, M | Osteogenesis imperfecta type VI | 1 mg/kg, 1×/month, 12 months | Not specified | 2 months | Hypercalcemia (not specified) | Not assessed | Not specified | Bisphosphonate (pamidronate) |
3 | Uday et al.; J Clin Endocrinol Metab.2018; 103:596 [7] | 15 years, M; 14 years, F; 40 years, M | Giant cell tumor of bone | 120 mg, 1×/week first month, then 1×/month, 3.6 years, 1.3 years, 4 years respectively | ONJ; end of treatment; femoral cortical stress reaction | 7 months; 6 months; 5.5 months | cCa 3.1 mmol/l; cCa 3.4 mmol/l; cCa 4.3 mmol/l; P normal | CTX 3070 ng/l, PTH suppressed | Nausea, vomiting, acute kidney injury, bone pain, inferior members paresthesia | Hyperhydration, furosemide, bisphosphonate (pamidronate) |
2 | Trejo et al.; J Musculosckelet Neuronal Interact. 2018; 18:76 [15] | 2.7 years M; 1.9 years M | Osteogenesis imperfecta type VI | 1.3 years, 2.6 years respectively | Study protocol | 12 weeks; 9 weeks | iCa 1.54 mmol/l; iCa 1.62 mmol/l | PTH suppressed, hypercalciuria, CTX elevated | Nephrocalcinosis | Bisphosphonate (pamidronate) |
1 | Tjelum et al.; Ugeskr Laeger.2018; 180(45) [14] | 77 years, F | Osteoporosis | 60 mg, 1×/6 months, for 2 years | Hypoparathyroid hypercalcemia and renal dysfunction | 6 months | Not specified | Hypercalcemia, PTH suppressed | Dehydration, severely impaired kidney function secondary to diarrhea | Rehydration |
1 | Roux et al.; Bone.2019; 120:482 [12] | 54 years, F | Adjuvant therapy for breast cancer (clinical trial); antiaromatase | 120 mg, 1×/month for 6 months, then quarterly, total 5 years | Absence of bone metastases; end of clinical trial | 4 months | cCa 3.1 mmol/l, P 1.3 mmol/l | CTX 669 ng/l, osteocalcin 64 μg/l | Polyuro-polydypsic syndrome, asthenia, severe constipation, diffuse pain in arms | Rehydration, bisphosphonate (pamidronate) 1×/month for 3 months |
1 | Uchida et al.; Endocr J. 2019. doi: 10.1507 [13] | 47 years, F | Adjuvant therapy for breast cancer (clinical trial); antiaromatase | 120 mg, 1×/month for 6 months, then quarterly, total 5 years | Absence of bone metastases; end of clinical trial | 6 months | cCa 3.59 mmol/l, P 1.29 mmol/l | NTX 510 nmol BCE/ mmol creat, PTH 2.43 pmol/l#, FGF-234000 pg/ml | Thirst, appetite loss, bilateral ankle pain | Bisphosphonate (zoledronate) |
1 | Dürr et al.; BMC Musculoskelet Disord. 2019 Oct 20; 20(1):456 [16] | 7 years, M | Giant cell tumor of bone | 60 mg, 1× in day 8 and 15, then 1/4 weeks, 1 year | Improvement of bone growth and healing of the cyst | 6 months | Not specified | Not specified | Not specified | Intensive care treatment necessary (not specified) |
1 | Upfill-Brown et al.; JBMR Plus. 2019; 3:e10210 [11] | 10 years, F | Aneurysmal bone cyst | 120 mg, 2×/month the first month, then 1×/month, total 15 doses | Excellent clinical and radiological response | 5 months | Ca 3.86 mmol/l, iCa 2.0 mmol/l | Not assessed | Severe diffuse abdominal pain, nausea, vomiting | Bisphosphonates, furosemide, calcitonin |
4 | Chawla et al.; Lancet Oncol. 2019 dec; 20(12):1719 [17] | 25–46 years, gender not specified | Giant cell tumor of bone | 120 mg, 1× in days 8 and 15, then 1/4 weeks, 6 months | Study protocol | 1 months | Not specified | Not specified | Not specified | Not specified |
1 | Actual case report | 86 years, F | Osteoporosis | 60 mg, 1×/6 months, 3 years | Unknown | 6 months | cCa 3.35 mmol/l, P 0.9 mmol/l | CTX 1777 ng/l, PTH suppressed | Anorexia, acute kidney injury, weight loss, malnutrition, bad health status | Rehydration, cinacalcet, calcitonin, restart DMAb |