From the Guidelines
Yes, Prolia (denosumab) can cause hypocalcemia, a condition of low blood calcium levels, which is a known and potentially serious side effect of the medication. This is supported by a study published in the Journal of the National Comprehensive Cancer Network, which found that hypocalcemia was more common with denosumab (13%) compared to zoledronic acid (6%) 1. Prolia works by inhibiting bone breakdown, which can lead to decreased calcium release from bones into the bloodstream. Hypocalcemia is more likely to occur in the first weeks after starting treatment, particularly in patients with pre-existing low calcium levels or kidney problems.
To reduce this risk, doctors often recommend calcium and vitamin D supplements for patients taking Prolia, as suggested by the American Society of Clinical Oncology clinical practice guideline update 1. It's crucial for patients on Prolia to have their calcium levels monitored regularly, especially in the initial weeks of treatment. If you're prescribed Prolia, ensure you discuss calcium supplementation with your healthcare provider and report any symptoms of hypocalcemia, such as muscle spasms, numbness, or tingling sensations.
Some key points to consider when taking Prolia include:
- Regular monitoring of calcium levels, especially in the initial weeks of treatment
- Calcium and vitamin D supplementation to reduce the risk of hypocalcemia
- Reporting any symptoms of hypocalcemia to your healthcare provider
- Avoiding invasive dental procedures while on therapy to reduce the risk of osteonecrosis of the jaw
- Maintaining excellent oral hygiene and regular dental check-ups while on therapy.
From the FDA Drug Label
Prolia can cause severe hypocalcemia and fatal cases have been reported. Pre-existing hypocalcemia must be corrected prior to initiating therapy with Prolia. Adequately supplement all patients with calcium and vitamin D
Yes, Prolia (denosumab) can cause hypocalcemia. It is recommended to correct pre-existing hypocalcemia before initiating therapy and to supplement all patients with calcium and vitamin D to minimize the risk of hypocalcemia 2.
From the Research
Hypocalcemia and Prolia (Denosumab)
- Prolia (denosumab) has been associated with hypocalcemia in several studies 3, 4, 5.
- Hypocalcemia following denosumab administration is well described, and it may be increased in patients with diseases related to high bone turnover, such as hyperthyroidism 4.
- The risk of denosumab-induced hypocalcemia may be higher in patients with advanced chronic kidney disease (CKD) 5.
- The initial dose of denosumab may pose a higher risk of hypocalcemia compared to subsequent doses, especially in patients with GFR of < 30 ml/min/1.73m2 5.
Mechanism and Treatment
- Denosumab works by targeting the receptor activator of nuclear factor kappa-B ligand (RANKL), which can lead to hypocalcemia 4.
- Treatment of denosumab-induced hypocalcemia may involve calcium and vitamin D supplementation 3, 4.
- Monitoring of serum calcium levels is recommended, especially in patients with CKD or other risk factors for hypocalcemia 5.
Patient Populations
- Patients with osteoporosis and advanced CKD are at increased risk for hypocalcemia when initiating denosumab 5.
- Patients with hyperthyroidism or other diseases related to high bone turnover may also be at increased risk of denosumab-induced hypocalcemia 4.
- Concurrent administration of denosumab and other medications, such as ferric carboxymaltose, may increase the risk of hypocalcemia 3.