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Potential association with early changes in serum calcium level after starting or switching to denosumab combined with eldecalcitol

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Abstract

The aims of this study are to investigate changes in serum calcium (Ca) level after switching from either non-therapy, bisphosphonate, selective estrogen receptor modulators (SERM) or teriparatide treatments to a combination therapy of denosumab (DMAb), and eldecalcitol, and the association between early changes in serum calcium and changes in bone metabolic markers and bone mineral density (BMD). 129 patients with postmenopausal osteoporosis (32 non-pretreatment, 50 bisphosphonates, 18 SERM, and 29 teriparatide) were recruited and switched to DMAb plus eldecalcitol. Serum calcium levels, bone metabolism markers, and BMD measurements of the lumbar spine and femoral neck were evaluated. All groups showed an increase in BMD 6 months and 1 year after DMAb administration compared to baseline via suppression of bone metabolism markers. The TPD group showed a significant decrease in serum calcium level 1 week after the first injection of DMAb and eldecalcitol compared to baseline and the bisphosphonate group. Changes in serum calcium level from baseline to 1 week after the first injection of DMAb trended to correlate with changes in bone metabolism markers and lumbar BMD. The risks of DMAb-induced hypocalcemia are different between starting and switching from bone resorption inhibitors and bone formation promoters. Therefore, appropriate assessment before administration of DMAb, including pretreatment therapy as well as serum Ca and bone metabolic markers will help identify the risk of hypocalcemia following DMAb in combination with eldecalcitol. Our findings also showed that early change in serum Ca level after DMAb initiation could potentially predict the efficacy for therapy reaction.

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Acknowledgements

This study was supported in part by a Grant-in-Aid for Scientific Research (C) from the Ministry of Education, Culture, Sports, Science, and Technology of Japan 17K10913 (T. Asano).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan

    Tsuyoshi Asano, Tomohiro Shimizu, Daisuke Takahashi, Masahiro Ota, Dai Sato, Hiroki Hamano, Shigeto Hiratsuka, Masahiko Takahata & Norimasa Iwasaki

  2. Department of Orthopaedic Surgery, Hokushokai Hospital, Iwamizawa, Japan

    Masahiro Ota

  3. Department of Orthopaedic Surgery, Iwamizawa City Hospital, Iwamizawa, Japan

    Dai Sato

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  1. Tsuyoshi Asano
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  2. Tomohiro Shimizu
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  3. Daisuke Takahashi
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  4. Masahiro Ota
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  8. Masahiko Takahata
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  9. Norimasa Iwasaki
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Correspondence to Daisuke Takahashi.

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Conflict of interest

Tsuyoshi Asano, Tomohiro Shimizu, Daisuke Takahashi, Masahiko Takahata, Hiroki Hamano, Masahiro Ota, Shigeto Hiratsuka, Dai Sato, and Norimasa Iwasaki declare that they have no conflict of interest.

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Tsuyoshi Asano and Tomohiro Shimizu contributed equally to this work.

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Asano, T., Shimizu, T., Takahashi, D. et al. Potential association with early changes in serum calcium level after starting or switching to denosumab combined with eldecalcitol. J Bone Miner Metab 37, 351–357 (2019). https://doi.org/10.1007/s00774-018-0928-x

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  • DOI: https://doi.org/10.1007/s00774-018-0928-x

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