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Denosumab-associated symptomatic hypophosphatemia in normal kidney function: two case reports.

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Severe hypophosphatemia, a serious complication, can occur after denosumab therapy for osteoporosis. Early monitoring and supplementation are crucial for managing this risk in patients.

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Area of Science:

  • Endocrinology
  • Nephrology
  • Pharmacology

Background:

  • Osteoporosis management often involves denosumab, a monoclonal antibody.
  • Severe hypophosphatemia is a rare but serious adverse effect associated with denosumab therapy.

Observation:

  • Two patients with osteoporosis developed symptomatic severe hypophosphatemia after denosumab treatment.
  • Patients presented with neurological symptoms and fatigue, despite normal kidney function and no prior risk factors.

Findings:

  • Intravenous phosphate supplementation normalized serum phosphate levels in both patients.
  • Patients were discharged with oral phosphate and, in one case, calcitriol therapy.

Implications:

  • Increased denosumab use necessitates vigilance for hypophosphatemia.
  • Regular monitoring of calcium, phosphate, and PTH, along with timely supplementation, may mitigate risks.
  • Consider hypophosphatemia in denosumab-treated patients experiencing unexplained fatigue or neurological symptoms.