From the Guidelines
Hypercalcemia causes falls primarily through its effects on the nervous system and muscles, leading to weakness, fatigue, and impaired coordination. When calcium levels in the blood become too high, it interferes with normal nerve and muscle function, resulting in symptoms such as confusion, altered mental status, and dizziness, which significantly increase fall risk 1.
Key Factors Contributing to Falls
- High calcium levels can cause muscle weakness and decreased muscle tone, making it difficult for individuals to maintain balance and proper gait
- Dehydration through increased urination can further contribute to orthostatic hypotension and dizziness when changing positions
- Severe hypercalcemia can cause cardiac arrhythmias and QT interval shortening, potentially leading to syncope
- Bone pain and fractures due to calcium being pulled from bones can create structural weakness that increases fall risk
Treatment and Management
Treatment of hypercalcemia involves addressing the underlying cause, ensuring adequate hydration, and sometimes using medications like bisphosphonates or calcitonin to lower calcium levels 1. According to the NCCN guidelines, bisphosphonates, such as zoledronic acid, are preferred for the treatment of hypercalcemia. Prompt recognition and management of hypercalcemia are crucial to prevent falls and other complications, and patients should be closely monitored for symptoms and treated accordingly.
From the Research
Hypercalcemia and Falls
- Hypercalcemia can cause a range of symptoms, including nausea, vomiting, dehydration, confusion, somnolence, and coma 2, 3, 4, 5, 6
- Severe hypercalcemia, defined as total calcium of 14 mg/dL or greater (>3.5 mmol/L) or ionized calcium of 10 mg/dL or greater (≥2.5 mmol/L), can lead to neurological symptoms such as confusion, somnolence, and coma 2
- These neurological symptoms can increase the risk of falls in patients with hypercalcemia 5
- Additionally, hypercalcemia can cause muscle weakness, which can also contribute to an increased risk of falls 6
- The exact mechanism of how hypercalcemia causes falls is not fully understood, but it is likely related to the combination of neurological and muscular symptoms 2, 3, 4, 5, 6
Treatment and Management
- Treatment of hypercalcemia typically involves hydration and intravenous bisphosphonates, such as zoledronic acid or pamidronate 2, 3
- In patients with severe hypercalcemia, treatment may also include glucocorticoids, calcitonin, and dialysis 2, 3, 4
- Identifying and treating the underlying cause of hypercalcemia is also crucial in managing the condition 2, 3, 4, 5, 6
- Patients with hypercalcemia should be closely monitored for symptoms and complications, including falls, and treated promptly to prevent long-term damage 2, 3, 4, 5, 6