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Severe hypocalcemia after denosumab in a patient with acquired Fanconi syndrome

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Abstract

We report the case of a 48-year-old man with acquired Fanconi syndrome due to IgG-kappa monoclonal gammopathy, who received a single dose of denosumab 60 mg for secondary prevention of skeletal fractures, in conjunction with oral calcium and vitamin D supplementation. The treatment was complicated with a severe, symptomatic hypocalcemia occurring 1 month after the injection and necessitating 4 weeks of intravenous calcium gluconate therapy. Similarly to bisphosphonates, inhibitors of the receptor activator of nuclear factor kappa-B ligand may not be appropriate for the treatment of acquired Fanconi syndrome and other forms of osteomalacia regardless of the degree of renal insufficiency and vitamin D levels. Clinicians should carefully interpret the radiographic and bone densitometry results in light of diverse mechanisms of bone demineralization and potential dependence of calcium homeostasis on high bone turnover.

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Correspondence to A. J. Olszewski.

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Shafqat, H., Alquadan, K.F. & Olszewski, A.J. Severe hypocalcemia after denosumab in a patient with acquired Fanconi syndrome. Osteoporos Int 25, 1187–1190 (2014). https://doi.org/10.1007/s00198-013-2533-0

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  • DOI: https://doi.org/10.1007/s00198-013-2533-0

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