Denosumab-induced hypocalcemia in a patient with hyperthyroidism: a case report

Area of Science:

• Endocrinology
• Pharmacology
• Bone Metabolism

Background:

• Denosumab, a monoclonal antibody targeting RANKL, is a key osteoporosis treatment.
• Osteoporosis management requires balancing treatment efficacy with potential adverse effects.
• Hyperthyroidism is characterized by a high bone turnover state, influencing bone metabolism.

Observation:

• A case study involving a postmenopausal woman with hyperthyroidism and osteoporosis treated with denosumab.
• The patient developed symptoms of hypocalcemia, including numbness and tingling.
• Laboratory results confirmed significantly low serum calcium levels.

Findings:

• Denosumab treatment in a patient with hyperthyroidism led to severe hypocalcemia.
• The high bone turnover state associated with hyperthyroidism may predispose patients to denosumab-induced hypocalcemia.
• Prompt administration of calcium and active vitamin D analogs resolved the hypocalcemia.

Implications:

• Clinicians should exercise caution when prescribing denosumab to patients with high bone turnover states, such as hyperthyroidism.
• Monitoring calcium levels is crucial in patients receiving denosumab, particularly those with concurrent conditions affecting bone metabolism.
• This case highlights the importance of individualized patient assessment to mitigate risks associated with osteoporosis therapies.