Severe, symptomatic hypocalcemia due to denosumab and vitamin d deficiency in a post–menopausal female with osteopenia

2020 ◽  
Author(s):  
John Berquist ◽  
Jason Kaplan ◽  
Andrew Zazaian
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Symptomatic Hypocalcemia ◽  
Post Menopausal

Symptomatic hypocalcemia following a single dose of zoledronic acid in a patient with bone metastases secondary to breast cancer

2020 ◽  
pp. 107815522094041
Author(s):  
Hasan Sözel ◽  
Fatih Yilmaz
Keyword(s):  
Breast Cancer ◽  
Vitamin D ◽  
Single Dose ◽  
Zoledronic Acid ◽  
Vitamin D Deficiency ◽  
Metastatic Breast ◽  
Post Menopausal Osteoporosis ◽  
Symptomatic Hypocalcemia ◽  
Precautionary Measures ◽  
Post Menopausal

Introduction The use of bisphosphonates is increasing, for treatment of hypercalcemia and pain in cancer, and post-menopausal osteoporosis and also to decrease the risk of skeletal morbidity in multiple myeloma and metastatic breast cancer. Case report A single dose of zoledronic acid was administered for hypercalcemia in a 54-year-old woman breast cancer patient with extensive bone metastasis. After the first dose, the patient developed symptomatic hypocalcemia. Management and outcome: Simultaneous hypocalcemia, hypophosphatemia, and vitamin D deficiency were detected in the patient. In the symptomatic process, intravenous, then oral replacement was performed. Discussion There is a need for taking precautionary measures such as vitamin D, serum phosphorus and, calcium monitoring and supplementation to prevent life-threatening complications, such as symptomatic hypocalcemia, especially in populations with vitamin D deficiency like ours.

scholarly journals Association of vitamin D and osteocalcin levels in post-menopausal women with osteoporosis

2017 ◽  
Vol 6 (4) ◽  
pp. 1244
Author(s):  
Yogiraj Vaijanathrao Chidre ◽  
Amir Babansab Shaikh
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Vitamin D Deficiency ◽  
Fragility Fractures ◽  
Bone Fragility ◽  
Vitamin D Supplementation ◽  
Mineral Density ◽  
Age Related ◽  
Calcium Phosphorus ◽  
Post Menopausal

Background: Osteoporosis is a common age related problem especially in women, with a consequent increase in bone fragility and susceptibility to fracture. Apart from Calcium, another nutrient that plays an important role in the mineralization of skeleton in Vitamin D. Osteocalcin, which is produced primarily by osteoblasts during bone formation, is considered to be one of the markers for osteoporosis.Methods: 314 women above the age of 40 were included into the study. A thorough physical and clinical examination, assessment of vital parameters, anthropometry evaluation was done for all patients. Bone mineral density was calculated using central DXA osteodensitometer at lumbar spine L1-L4, hip and ultradistal radius (in some cases.). Blood samples were taken for the detection of ionized calcium, phosphorus, alkaline phosphatase, 25hydroxivitamin D (25 ODH) and serum parathyroid hormone (PTH) by chemiluminiscent assay. Bone markers such as osteocalcin were measured as required.Results: Out of the 314 women attending our OPD, 96 of them were diagnosed as having osteoporosis. 24 out of them had fragility fractures, mainly of the hip, and 82 had ostepenia. Elevated levels of calcium (8.96 mg/dl), parathyroid hormone (58.76 pg/ml) and osteocalcin (24.46 ng/ml) were observed. Vitamin D deficiency of ≤ 20 was seen in 59 (63%) of the cases, insufficient in 23 (24%) and only 12 (13%) of these women had normal Vitamin D levels.Conclusions: Osteocalcin is a promising marker for the detection of osteoporosis. There is a considerable Vitamin D deficiency among the women with osteoporosis, and it is under-treated. It is essential to provide Vitamin D supplementation to these women especially those who are at high risk for fragility fractures.

Depressive symptoms and bone mineral density in menopause and postmenopausal women: A still increasing and neglected problem

2016 ◽  
Vol 33 (S1) ◽  
pp. S119-S119
Author(s):  
A. Bener
Keyword(s):  
Blood Pressure ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Diastolic Blood Pressure ◽  
Postmenopausal Women ◽  
Bone Mineral ◽  
Smoking Habits ◽  
Menopausal Women ◽  
The Mean ◽  
Post Menopausal

ObjectiveThe objective of current study was to investigate whether associaction exist between depression and low BMD during menopausal and post-menopausal period.MethodsA cross-sectional descriptive study and 1650 women aged 45–65 years were included during 1182 women agreed to participate (71.6%). Data on body mass index (BMI), clinical biochemistry variables including serum 25-hydroxyvitamin D were collected. The Beck Depression Inventory (BDI) was administered for depression purposes.ResultsA total of 1182 women agreed to participate and responded to the study. The mean age and SD of the menopausal age were 48.71 ± 2.96 with depressed and 50.20 ± 3.22 without depressed (P < 0.001). Also, the mean and SD of postmenopausal age were 58.55 ± 3.27 depressed and 57.78 ± 3.20 without depressed (P < 0.001). There were statistically significance differences between menopausal stages with regards to number of parity, and place of living. There were statistically significance differences between menopausal stages with regards to BMI, systolic and diastolic blood pressure, vitamin D deficiency, calcium deficiency and sheesha smoking habits. Overall, osteopenia and osteoporosis and bone loss were significantly lower in post-menopausal women than in menopausal women (P < 0.001). Similarly, T-score and z-score were lower with depressed menopause and postmenopausal women (P < 0.001).ConclusionThe multivariate logistic regression analyses revealed that the depression, the mean serum vitamin D deficiency, calcium level deficiency, less physical activity, co-morbidity, number of parity, systolic and diastolic blood pressure and sheesha smoking habits were considered as the main risk factors associated with bone mineral loss after adjusting for age, BMI and other variables.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

scholarly journals A Review on Vitamin D Deficiency Treatment in Pediatric Patients

2013 ◽  
Vol 18 (4) ◽  
pp. 277-291 ◽  
Author(s):  
Ji Yeon Lee ◽  
Tsz-Yin So ◽  
Jennifer Thackray
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Pediatric Patients ◽  
Calcium Absorption ◽  
Pediatric Population ◽  
Vitamin D Supplementation ◽  
The Body ◽  
Nutritional Deficiencies ◽  
Bone Demineralization ◽  
Symptomatic Hypocalcemia

Vitamin D is essential for calcium absorption and for maintaining bone health in the pediatric population. Vitamin D deficiency may develop from nutritional deficiencies, malabsorption, enzyme-inducing medications, and many other etiologies. It may present as hypocalcemia before bone demineralization at periods of increased growth velocity (infancy and adolescence) because the increased calcium demand of the body cannot be met. In children, inadequate concentrations of vitamin D may cause rickets and/or symptomatic hypocalcemia, such as seizures or tetany. In this review, we will discuss the pharmacology behind vitamin D supplementation, laboratory assessments of vitamin D status, current literature concerning vitamin D supplementation, and various supplementation options for the treatment of vitamin D deficiency in the pediatric population.

scholarly journals Vitamin D status among postmenopausal osteoporotic women: a hospital based cross-sectional study from Northern Sri Lanka.

2020 ◽  
Author(s):  
Navaneethakrishnan Suganthan ◽  
Thirunavukarasu Kumanan ◽  
Vithegi Kesavan ◽  
Mahalingam Aravinthan ◽  
Nadarajah Rajeshkannan
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Serum Vitamin ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
Menopausal Women ◽  
Post Menopausal

Abstract Background Vitamin D deficiency is common among post-menopausal women and it is important to treat vitamin D deficiency to prevent falls and fractures in patients with osteoporosis. Few studies examined the prevalence of vitamin D deficiency in general population of Sri Lanka but no studies to date done among post-menopausal women with osteoporosis. This is the first study of such kind conducted to evaluate the serum vitamin D levels and factors related to Vitamin D deficiency among postmenopausal women.Methodology Hospital based Cross -sectional study was conducted at the Endocrine Unit, Teaching Hospital from January to December 2018.During the study period 105 postmenopausal women registered for DEXA scan with Endocrine Unit were recruited to the study. Data collection was done by investigators and blood sample was taken from each participant by registered nursing officers and sample was analysed by using immunohistochemistry assays. Serum Vitamin D levels were categorized and data analysis was done using SPSS 26.Results Mean age of 105 postmenopausal women was 67.7 with minimum 33 and maximum 84 years. Mean Vitamin D levels were 27.5(range11.7-52.5ng/ml). Vitamin D levels were adequate in only 36.2% (95%CI: 27.4-45.7) of women, 44% had insufficient levels and deficiency was present in 19% (95%CI: 12.4-27.4) of participants. Among the 105 women 20% were vegetarian and 53% of them consuming milk on average 3 days per week, 76.2% consuming fish on average 2 days per week, 64.8% consuming egg on average 1 day per week. Furthermore seventy five participants (71.4%) reported adequate level of sun exposure (>30minutes).Commonly reported vitamin deficiency symptoms includes paraesthesia (57.1%),bone pain (55.2%), easy fatigability (54.3%), malaise (51.4%), muscle cramps (43.8%) and proximal myopathy (40.0%).Among 71(66.7%) completed bone density assessment,38% (27.3-49.7) of them showed osteoporosis range. Vertebral Z score showed a significant correlation with vitamin D level(r-0.252, P-0.034).Conclusion Prevalence of vitamin D deficiency is relatively high among the post-menopausal women with a provisional diagnosis of osteoporosis. It is essential to correct vitamin D deficiency with supplementation when initiating treatment for osteoporosis. So vitamin D testing is desirable in decision making to treat or not to treat.

The combination of vitamin D deficiency and overweight affects muscle mass and function in older post-menopausal women

2018 ◽  
Vol 30 (6) ◽  
pp. 625-631 ◽  
Author(s):  
Francesca Gimigliano ◽  
Antimo Moretti ◽  
Alessandro de Sire ◽  
Dario Calafiore ◽  
Giovanni Iolascon
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Muscle Mass ◽  
Menopausal Women ◽  
Post Menopausal ◽  
And Function

Hypocalcemia induced by bisphophonates in cancer patients with vitamin D deficiency

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19644-19644
Author(s):  
C. F. Yazbeck ◽  
A. M. Gonzalez-Angulo ◽  
S. A. Shaw ◽  
S. G. Waguespack ◽  
R. Vassilopoulou-Sellin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Vitamin D ◽  
Metastatic Breast Cancer ◽  
Vitamin D Deficiency ◽  
Cancer Patients ◽  
Metastatic Breast ◽  
Zolendronic Acid ◽  
Vitamin D Levels ◽  
Symptomatic Hypocalcemia ◽  
Normal Albumin

19644 Background: The use of bisphosphonates for treatment of hypercalcemia, bone pain and reduction of skeletal morbidity in metastatic breast cancer is increasing. Moreover, vitamin D deficiency is commonly associated with cancer. Hypocalcemia has been reported following IV bisphosphonate use. Methods: We present the clinical and lab findings in 6 cases of bisphosphonate-induced hypocalcemia, caused by unmasked vitamin D deficiency. Results: Our 1st patient was diagnosed with breast cancer and developed metastases 6yrs later. She was given Zolendronic acid 4 mg IV with a baseline calcium level (Ca) of 9.7 mg/dl, normal albumin, and elevated alkaline phosphatase. 3 days later, she developed symptomatic severe hypocalcemia with tetany: Ca dropped to 6.1 mg/dl with recovery. After her 2nd dose of Zolendronic acid, Ca dropped again to 6 mg/dl with normal albumin, intact parathyroid hormone (PTH) of 637 pg/ml (range 10–65) and 25-hydroxy vitamin D levels (25-OHD) of 4 ng/ml (range 20–100). Our 2nd patient presented with metastatic breast cancer and was treated with Zolendronic acid for hypercalcemia with a baseline Ca of 13 mg/dl, PTH-related protein of 2.8 pmol/l (range <1.8) and PTH of 7 pg/ml. She then developed hypocalcemia with corrected Ca of 7.7 mg/dl and 25-OHD of 13 ng/ml. Our 3rd patient with breast cancer was also treated with Zolendronic acid for bone metastases and hypercalcemia. She then presented with symptomatic hypocalcemia: ionized Ca level of 1.09 mmol/l (range 1.13–1.32), PTH of 211 pg/ml and 25-OHD of 13 ng/ml. Our other 3 cases had similar presentations to the above and will be discussed in detail. All 6 cases were treated with ergocalciferol and long-term oral calcium and vitamin D therapy. All of our cases presented with symptomatic hypocalcemia with vitamin D levels less than 30ng/mL. Conclusions: Since bisphosphonate use is increasing in cancer patients and vitamin D deficiency is not an uncommon finding in this population, consideration should be given to routine checking of 25-OHD levels before initiating treatment with bisphosphonates and supplementing with calcium and vitamin D when necessary (<30ng/mL). This could potentially prevent further morbidity. Further prospective studies would be needed for early replacement with vitamin D and calcium in those with vitamin D deficiency. No significant financial relationships to disclose.

scholarly journals Vitamin D status among postmenopausal osteoporotic women: a hospital based cross-sectional study from Northern Sri Lanka.

2019 ◽  
Author(s):  
Navaneethakrishnan Suganthan ◽  
Thirunavukarasu Kumanan ◽  
Vithegi Kesavan ◽  
Mahalingam Aravinthan ◽  
Nadarajah Rajeshkannan
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Serum Vitamin ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
Menopausal Women ◽  
Post Menopausal

Abstract Background Vitamin D deficiency is common among post-menopausal women and it is important to treat vitamin D deficiency to prevent falls and fractures in patients with osteoporosis. Few studies examined the prevalence of vitamin D deficiency in general population of Sri Lanka but no studies to date done among post-menopausal women with osteoporosis. This is the first study of such kind conducted to evaluate the serum vitamin D levels and factors related to Vitamin D deficiency among postmenopausal women.Methodology Hospital based Cross -sectional study was conducted at the Endocrine Unit, Teaching Hospital from January to December 2018.During the study period 105 postmenopausal women registered for DEXA scan with Endocrine Unit were recruited to the study. Data collection was done by investigators and blood sample was taken from each participant by registered nursing officers and sample was analysed by using immunohistochemistry assays. Serum Vitamin D levels were categorized and data analysis was done using SPSS 26.Results Mean age of 105 postmenopausal women was 67.7 with minimum 33 and maximum 84 years. Mean Vitamin D levels were 27.5(range11.7-52.5ng/ml). Vitamin D levels were adequate in only 36.2% (95%CI: 27.4-45.7) of women, 44% had insufficient levels and deficiency was present in 19% (95%CI: 12.4-27.4) of participants. Among the 105 women 20% were vegetarian and 53% of them consuming milk on average 3 days per week, 76.2% consuming fish on average 2 days per week, 64.8% consuming egg on average 1 day per week. Furthermore seventy five participants (71.4%) reported adequate level of sun exposure (>30minutes).Commonly reported vitamin deficiency symptoms includes paraesthesia (57.1%),bone pain (55.2%), easy fatigability (54.3%), malaise (51.4%), muscle cramps (43.8%) and proximal myopathy (40.0%).Among 71(66.7%) completed bone density assessment,38% (27.3-49.7) of them showed osteoporosis range. Vertebral Z score showed a significant correlation with vitamin D level(r-0.252, P-0.034).Conclusion Prevalence of vitamin D deficiency is relatively high among the post-menopausal women with a provisional diagnosis of osteoporosis. It is essential to correct vitamin D deficiency with supplementation when initiating treatment for osteoporosis. So vitamin D testing is desirable in decision making to treat or not to treat.

scholarly journals Vitamin D status among postmenopausal osteoporotic women: a hospital based cross-sectional study from Northern Sri Lanka.

2020 ◽  
Author(s):  
Navaneethakrishnan Suganthan ◽  
Thirunavukarasu Kumanan ◽  
Vithegi Kesavan ◽  
Mahalingam Aravinthan ◽  
Nadarajah Rajeshkannan
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Serum Vitamin ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
Menopausal Women ◽  
Post Menopausal

Abstract Background Vitamin D deficiency is common among post-menopausal women and it is important to treat vitamin D deficiency to prevent falls and fractures in patients with osteoporosis. Few studies examined the prevalence of vitamin D deficiency in general population of Sri Lanka but no studies to date done among post-menopausal women with osteoporosis. This is the first study of such kind conducted to evaluate the serum vitamin D levels and factors related to Vitamin D deficiency among postmenopausal women.Methodology Hospital based Cross -sectional study was conducted at the Endocrine Unit, Teaching Hospital from January to December 2018.During the study period 105 postmenopausal women registered for DEXA scan with Endocrine Unit were recruited to the study. Data collection was done by investigators and blood sample was taken from each participant by registered nursing officers and sample was analysed by using immunohistochemistry assays. Serum Vitamin D levels were categorized and data analysis was done using SPSS 26.Results Mean age of 105 postmenopausal women was 67.7 with minimum 33 and maximum 84 years. Mean Vitamin D levels were 27.5(range11.7-52.5ng/ml). Vitamin D levels were adequate in only 36.2% (95%CI: 27.4-45.7) of women, 44% had insufficient levels and deficiency was present in 19% (95%CI: 12.4-27.4) of participants. Among the 105 women 20% were vegetarian and 53% of them consuming milk on average 3 days per week, 76.2% consuming fish on average 2 days per week, 64.8% consuming egg on average 1 day per week. Furthermore seventy five participants (71.4%) reported adequate level of sun exposure (>30minutes).Commonly reported vitamin deficiency symptoms includes paraesthesia (57.1%),bone pain (55.2%), easy fatigability (54.3%), malaise (51.4%), muscle cramps (43.8%) and proximal myopathy (40.0%).Among 71(66.7%) completed bone density assessment,38% (27.3-49.7) of them showed osteoporosis range. Vertebral Z score showed a significant correlation with vitamin D level(r-0.252, P-0.034).Conclusion Prevalence of vitamin D deficiency is relatively high among the post-menopausal women with a provisional diagnosis of osteoporosis. It is essential to correct vitamin D deficiency with supplementation when initiating treatment for osteoporosis. So vitamin D testing is desirable in decision making to treat or not to treat.

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