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Endocrine Abstracts (2017) 49 EP294 | DOI: 10.1530/endoabs.49.EP294

Universitary Hospital Son Espases, Palma de Mallorca, Spain.


Introduction: Denosumab is a monoclonal antibody indicated in the treatment of postmenopausal osteoporosis. Hypocalcemia is a rare adverse effect.

Case report: We present the case of a 58-year-old woman with a clinical history of bariatric surgery in 2001 and osteoporosis with multiple vertebral and hip fractures. Under treatment with Zinc sulphate, Vitamin A, 25-OH-vitamin D, calcium and iron. She came to the A&E for general malaise, generalized weakness, paraesthesia, dysarthria and weight loss of some weeks of evolution. She was admitted due to a severe hypocalcemia: calcium 5 mg/dl (8.4–10.2), ionic calcium 2.5 mg/dl (4.64–5.28), phosphate 1.2 mg/dl (2.3–4.7), magnesium 2.35 mg/dl (1.6–2.6), albumin 38.8 g/l (35–50), PTH 284 pg/ml (15–65), 25-OH-vitamin D 22 ng/ml (30–100), alkaline phosphatase 360 U/l (40–150) and normal kidney function. The ECG showed a prolonged QT. The signs for hypocalcaemia were negative. The patient had received treatment with subcutaneous Denosumab 60 mg 22 days before, with prior calcium values of 8.4 mg/dl, phosphorous 3.1 mg/dl, 25-OH-vitamin D 25 ng/ml, PTH 76 pg/ml and Ca-urine 27 mg/24 h. Treatment was started with intravenous calcium for 8 weeks, together with oral calcium, phosphorous and 25-OH-vitamin D. The patient improved symptomatically, with a normalization of the QT and analysis with ionic calcium 4.6 mg/dl, phosphate 3.5 mg/dl, magnesium 2.8 mg/dl, PTH 139 pg/ml, Ca-urine 2.3 mg/dl and 25-OH-vitamin D 39 ng/ml. The treatment to discharge was oral calcium 2.5 g/day and 25-OH-vitamin D 16.000 UI daily.

Conclusions: Hypocalcemia after Denosumab is a rare adverse effect but it can be serious. The patients who have undergone malabsortive bariatric surgery have a greater risk. It is important to monitor the 25-OH-vitamin D and calcium in patients who start treatment with Denosumab and at 15 days in patients who are at the greatest risk, as is the case of this patient.

Volume 49

19th European Congress of Endocrinology

Lisbon, Portugal
20 May 2017 - 23 May 2017

European Society of Endocrinology 

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