The Development of Immobilization Induced Hypercalcemia in the Outpatient Setting - A Case Report

Immobilization induced hypercalcemia is an uncommon and serious disorder that requires a thorough evaluation to exclude more common causes of an elevated calcium. Although the pathogenesis is not clearly illuminated, immobilization results in an uncoupling between osteogenic and osteoclastic factors that maintain bone homeostasis. When calcemic bone resorption overwhelms urinary calcium excretion, blood hypercalcemia ensues. Immediate management is similar to other hypercalcemic treatments, while definitive resolution may require bisphosphonates, denosumab, and mobilization. An asymptomatic presentation and other alterations of calcium homeostasis may complicate immobilization induced hypercalcemia. Because of the severe nature of the inciting events surrounding patient immobilization, immobilization induced hypercalcemia is rarely diagnosed in the outpatient setting. However, as seen in our case, outpatient diagnosis may still occur. We highlight the keen awareness and high index of suspicion that primary care providers should maintain to best serve our patients. We report a unique case of immobilization induced hypercalcemia, preceded by traumatic hypocalcemia, that developed and was first evaluated in the outpatient setting.