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Efficacy of denosumab in the treatment of hypercalcemic renal dysfunction in sarcoidosis: a case report

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Abstract

A 70-year-old female patient was admitted for close examination and treatment of hypercalcemia (corrected serum calcium levels: 3.04 mmol/L) and renal dysfunction (serum creatinine levels: 254.59 µmol/L). The patient had a history of sarcoidosis, diagnosed based on epithelioid cell granulomas in subcutaneous nodule biopsies, uveitis, and bilateral hilar lymphadenopathy, which had spontaneously remitted 10 years before admission. Because the patient was diagnosed with hypercalcemia associated with recurrent sarcoidosis, prednisone (20 mg/day) was initiated, and its dose was tapered following the decrease in serum calcium and creatinine levels. However, the levels of these parameters increased again when the prednisone dose was reduced to ≤ 4 mg/day. We were concerned about glucocorticoid-induced osteoporosis in the patient but hesitated to use first-line bisphosphonates because of renal dysfunction. Therefore, denosumab was initiated to reduce the risk of hypercalcemia, renal dysfunction, and glucocorticoid-induced osteoporosis. Serum creatinine and corrected serum calcium levels subsequently decreased. The prednisone dose could be reduced following repeated denosumab administration.

Thus, denosumab can be a multifaceted, beneficial option for sarcoidosis-induced hypercalcemia, as it alleviates renal dysfunction indirectly by normalizing serum calcium levels, facilitates reduction of the glucocorticoid dose, and ameliorates glucocorticoid-induced osteoporosis.

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Data are available to academic investigators from the authors upon reasonable request.

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Funding

This case report did not receive grants from public, commercial, or not-for-profit funding agencies.

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Authors and Affiliations

  1. Department of General Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan

    Naoya Fujita, Yosuke Ono, Kenichi Hashimoto, Yusuke Kawamura, Motohiro Kimata, Akinori Sekizawa, Yasuhiro Obuchi & Yuji Tanaka

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  1. Naoya Fujita
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  2. Yosuke Ono
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  3. Kenichi Hashimoto
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  4. Yusuke Kawamura
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  7. Yasuhiro Obuchi
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Correspondence to Naoya Fujita.

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Naoya Fujita, Yosuke Ono, Kenichi Hashimoto, Yusuke Kawamura, Motohiro Kimata, Akinori Sekizawa, Yasuhiro Obuchi, and Yuji Tanaka declare that they have no conflict of interest.

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Fujita, N., Ono, Y., Hashimoto, K. et al. Efficacy of denosumab in the treatment of hypercalcemic renal dysfunction in sarcoidosis: a case report. Osteoporos Int 35, 733–736 (2024). https://doi.org/10.1007/s00198-023-06998-y

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