Denosumab-associated hypocalcemia: Does gender play a role?

Area of Science:

• Endocrinology
• Gerontology
• Pharmacology

Background:

• Disease presentation, treatment, and outcomes can differ between genders.
• A prior study reported a 7.4% rate of denosumab-associated hypocalcemia in osteoporotic patients.

Purpose of the Study:

• To investigate the role of gender in denosumab-associated hypocalcemia.
• To analyze rates and predictors of hypocalcemia by gender in osteoporotic patients.

Main Methods:

• Retrospective cohort study of community-dwelling patients treated with denosumab for osteoporosis (2010-2018).
• Analysis of denosumab-associated hypocalcemia (serum calcium ≤8.5 mg/mL) rates and predictors by gender.
• Propensity matching of male and female patients.

Main Results:

• The cohort included 1871 women and 134 men. Men were older, more likely to receive denosumab as first-line treatment, less likely to take calcium supplements, and had lower eGFR.
• Hypocalcemia developed in 7.1% of women and 11.9% of men (p=0.04).
• On propensity matching, gender was not a predictor of hypocalcemia, suggesting selection bias.

Conclusions:

• Denosumab-treated men had older age, lower eGFR, and more advanced osteoporosis compared to women.
• The higher rate of hypocalcemia in men appears to be due to selection bias, not male gender per se.
• These findings highlight the importance of considering patient characteristics in osteoporosis treatment.