Treatment of Hypercalcemia of Malignancy
Marlene Chakhtoura1, Ghada El-Hajj Fuleihan1
1Calcium Metabolism and Osteoporosis Program, Division of Endocrinology, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut, PO Box 11-236, Riad El-Solh, Beirut 1107 2020, Lebanon.
Abstract:
The treatment of hypercalcemia of malignancy (HCM) consists of enhancing renal calcium excretion, mostly through hydration with isotonic fluids and the use of antiresorptive therapies. Intravenous zoledronic acid is currently the first-line treatment. Subcutaneous denosumab is used for bisphosphonate-refractory hypercalcemia and in patients with renal failure. There is no evidence that bisphosphonates prevent the occurrence of HCM. Conversely, denosumab, compared with zoledronic acid, is associated with a lower risk of HCM, both first episode and recurrence, in patients with breast cancer and multiple myeloma.
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