[Symptomatic hypocalcaemia on denosumab use].

Area of Science:

• Endocrinology
• Metabolic Bone Disease
• Pharmacology

Background:

• Bone resorption inhibitors, such as denosumab, are critical in managing osteoporosis.
• Vitamin D deficiency is a known risk factor for symptomatic hypocalcaemia when initiating these therapies.
• Bariatric surgery is a potential cause of nutrient deficiencies, including vitamin D.

Observation:

• A 51-year-old woman developed symptomatic hypocalcaemia after starting denosumab treatment.
• The patient had a history of bariatric surgery several years prior to denosumab initiation.
• This case highlights a potential drug-nutrient interaction in a specific patient population.

Findings:

• Denosumab therapy precipitated symptomatic hypocalcaemia in a patient with pre-existing vitamin D deficiency.
• The history of bariatric surgery likely contributed to the patient's compromised vitamin D status.
• This underscores the importance of assessing vitamin D levels before prescribing bone resorption inhibitors.

Implications:

• Routine screening and optimization of vitamin D and calcium levels are essential before initiating bone resorption inhibitors.
• Clinicians should consider prior bariatric surgery as a risk factor for vitamin D deficiency in patients prescribed denosumab.
• Proactive management of nutrient status can prevent adverse events like hypocalcaemia in osteoporosis treatment.