Kritzinger Justin, Wyse Jonathan, Karaplis Andrew
Internal Medicine, McGill University, Montreal, Quebec, Canada
Division of Gastroenterology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
BMJ Case Rep. 2024 Dec 18;17(12):e262595. doi: 10.1136/bcr-2024-262595.
Serum calcium and phosphorus levels are tightly regulated by the calciotropic hormone parathyroid hormone, fibroblast growth factor 23 and 1,25(OH) vitamin D. Commonly prescribed therapies for iron-deficiency anaemia (IDA) such as ferric carboxymaltose and ferric derisomaltose (FDM) have been shown to disrupt phosphorus homeostasis, resulting in hypophosphataemia. Similarly, denosumab use can result in hypocalcaemia due to the inhibition of osteoclastic maturation, activity and survival. Here, we report the development of severe hypophosphataemia and hypocalcaemia in a patient with osteoporosis and IDA following treatment with denosumab and FDM. The patient remained asymptomatic; however, supplementation with calcium, phosphorus and calcitriol replacement was required prior to eventual normalisation of serum levels. Often concomitantly prescribed, little guidance exists regarding electrolyte disturbances following the administration of FDM and denosumab. While hypophosphataemia and hypocalcaemia are relatively uncommon when prescribed individually, synergistic effects likely exist that warrant regular monitoring and occasional supplementation.
血清钙和磷水平受到钙调节激素甲状旁腺激素、成纤维细胞生长因子23和1,25(OH)维生素D的严格调控。常用的缺铁性贫血（IDA）治疗药物，如羧基麦芽糖铁和去铁胺麦芽糖铁（FDM），已被证明会破坏磷稳态，导致低磷血症。同样，地诺单抗的使用会因抑制破骨细胞成熟、活性和存活而导致低钙血症。在此，我们报告了一名骨质疏松症和IDA患者在接受地诺单抗和FDM治疗后发生严重低磷血症和低钙血症的情况。患者无症状；然而，在血清水平最终恢复正常之前，需要补充钙、磷并使用骨化三醇替代治疗。FDM和地诺单抗通常是联合使用的，但关于它们给药后电解质紊乱的指导很少。虽然单独使用时低磷血症和低钙血症相对不常见，但可能存在协同作用，需要定期监测并偶尔进行补充。
