Nizeyimana Jean Damascene, Dreessen Lisa, Andreescu Corina, Duhamel Adriaan, Lieten Siddhartha, Balti Eric
Department of Geriatric Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Jette, Brussels, Belgium.
Department of Endocrinology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Jette, Brussels, Belgium.
JCEM Case Rep. 2025 Jun 13;3(8):luaf121. doi: 10.1210/jcemcr/luaf121. eCollection 2025 Aug.
Denosumab is a frequently used medication, mainly for the treatment of osteoporosis and prevention of skeletal-related events in patients with metastatic cancer. However, the treatment can be associated with adverse events including hypocalcemia. We discuss the therapeutic challenges of denosumab-induced hypocalcemia in a patient with metastatic prostate adenocarcinoma. This 87-year-old patient presented to the emergency department after being found on the floor with altered mental status. Denosumab had been initiated 3 weeks earlier for stage 4 prostate adenocarcinoma with osteoblastic bone metastatic lesions. Blood analyses showed severe hypocalcemia (3.89 mg/dL [0.97 mmol/L]), which did not improve despite progressive incremental parenteral calcium administration and cholecalciferol supplementation. Management required 64 days of admission and titration of calcitriol. The patient was discharged after stabilizing plasma calcium level. Outpatient palliative care was later initiated because of progressive prostate adenocarcinoma, which ultimately led to the patient's death. Patients with metastatic bone disease, especially when treated with denosumab for prevention of skeletal-related events, present an increased risk of severe and even refractory hypocalcemia. More data are needed for optimal risk stratification of these patients, to identify robust predictors of hypocalcemia and to define the appropriate timing for starting calcium and vitamin D supplementation in high-risk individuals.
地诺单抗是一种常用药物，主要用于治疗骨质疏松症以及预防转移性癌症患者的骨相关事件。然而，该治疗可能会引发包括低钙血症在内的不良事件。我们讨论了一名转移性前列腺腺癌患者中地诺单抗诱导的低钙血症的治疗挑战。这位87岁的患者在被发现倒在地上且意识状态改变后被送往急诊科。3周前因患有成骨性骨转移病变的4期前列腺腺癌开始使用地诺单抗治疗。血液分析显示严重低钙血症（3.89mg/dL[0.97mmol/L]），尽管逐步增加静脉注射钙剂并补充胆钙化醇，但低钙血症仍未改善。治疗需要住院64天并滴定骨化三醇。患者在血浆钙水平稳定后出院。后来由于前列腺腺癌进展开始了门诊姑息治疗，最终导致患者死亡。患有转移性骨病的患者，尤其是在接受地诺单抗治疗以预防骨相关事件时，出现严重甚至难治性低钙血症的风险增加。需要更多数据来对这些患者进行最佳风险分层，以识别低钙血症的可靠预测指标，并确定高危个体开始补充钙剂和维生素D的合适时机。
