THE USE OF ORAL BISPHOSPHONATES IN REFRACTORY SEVERE HYPERCALCEMIA AFTER DENOSUMAB CESSATION

Area of Science:

• Oncology
• Pharmacology
• Pediatrics

Background:

• Denosumab, a RANK-L inhibitor, is used for giant cell bone tumors.
• Hypercalcemia, particularly severe rebound hypercalcemia post-discontinuation, is a significant side effect, especially in pediatric patients.
• Management of recurrent hypercalcemia necessitates effective therapeutic strategies to minimize complications and hospital stays.

Observation:

• A case report details a 9-year-old treated for recurrent severe hypercalcemia after denosumab cessation for a giant cell bone tumor.
• Initial treatment with IV bisphosphonates was followed by oral bisphosphonates (alendronate) for persistent mild hypercalcemia.
• Calcium levels normalized and remained stable below 10.5 mg/dl after initiating oral bisphosphonate therapy.

Findings:

• Oral bisphosphonates demonstrate efficacy in managing rebound hypercalcemia following denosumab therapy.
• Long-term oral bisphosphonate use can effectively control recurrent hypercalcemia episodes and reduce hospitalization.
• Close monitoring is crucial, especially in children, due to the unpredictable nature of rebound hypercalcemia after denosumab discontinuation.

Implications:

• Oral bisphosphonates offer a viable and effective long-term management strategy for denosumab-induced hypercalcemia.
• This therapeutic option can improve patient outcomes by reducing the burden of recurrent hypercalcemia and associated hospitalizations.
• Further research into optimal dosing and long-term safety of oral bisphosphonates for this indication is warranted.