scholarly journals Drug-induced hypocalcemia

2021 ◽  
pp. 164-175
Author(s):  
A. I. Listratov ◽  
O. D. Ostroumova ◽  
M. V. Klepikova ◽  
E. V. Aleshkovich
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Clinical Practice ◽  
Calcium Absorption ◽  
Drug Induced ◽  
Leading Role ◽  
Electrolyte Disturbances ◽  
Tuberculosis Therapy ◽  
Attending Physicians ◽  
Electrocardiogram Ecg

Hypocalcemia (HCa) is one of the main water-electrolyte disturbances in clinical practice. An acute decrease in serum calcium levels can lead to seizures, ventricular arrhythmias, bronchospasm and laryngospasm. Chronic HCa can result in disorientation and confusion. To prevent these complications, the risk factors for low calcium levels must be carefully evaluated. One of these factors is drugs, in which case we are talking about drug-induced (DI) HCa. The list of drugs-inducers of DI HCa is quite extensive, but the leading role in this disorder is played by drugs for the treatment of osteoporosis, antineoplastic and antiepileptic drugs, as well as drugs for anti-tuberculosis therapy. When taking zoledronic acid, DI HCa is observed with a frequency of up to 39%. When taking imatinib, a targeted anticancer drug, a decrease in calcium levels was observed in 40% of cases. The pathophysiological mechanisms of DI HCa can be a decrease in bone resorption, a decrease in the concentration of vitamin D, inhibition of the action of parathyroid hormone and impaired calcium absorption. Risk factors in most cases of DI HCa are vitamin D deficiency and hypomagnesemia. An acute decrease in calcium levels leads to symptoms of neuromuscular excitability, abnormalities on the electrocardiogram (ECG) and electroencephalogram (EEG). The basis for the treatment of DI HCa is the drug withdrawal and the appointment of calcium. It is also necessary to prescribe vitamin D. The main methods of prevention of DI HCa are to determine the level of calcium and vitamin D before starting therapy with culprit medication, and to correct its level. It is also important to prescribe additional amounts of calcium and vitamin D during therapy with such drugs. Awareness of the attending physicians about the problem of DI HCa, a thorough assessment of its risk factors and the prophylactic administration of calcium and vitamin D preparations will help to effectively prevent those serious complications resulting from a decrease in calcium levels in clinical practice.

scholarly journals Sarcoporosis Is a Part of Aging

2019 ◽  
Vol 120 (2-3) ◽  
pp. 84-94
Author(s):  
Petr Broulík
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Calcium Absorption ◽  
Serum Alkaline Phosphatase ◽  
Aging Treatment ◽  
Laboratory Findings ◽  
Senile Osteoporosis ◽  
Public Health Burden ◽  
Low Level ◽  
Age Related

Ageing is associated with the accumulation of damage to all the macromolecules within and outside cells leading to progressively more cellular and tissue defects and resulting in age-related frailty, disability and disease. As a result of the aging process the bone deteriorates in composition, structure and function. Age-related musculoskeletal losses are a major public health burden because they can cause physical disability and increased mortality. We tried to find out on a small set of old women, without risk factors for osteoporosis, what caused them the loss of bone minerals. All 492 women had just only one risk factor – the old age. Laboratory findings have shown a decreased serum C telopeptide and low serum alkaline phosphatase circulating markers, used to quantify bone resorption and formation, and very low level of vitamin D. Very low level of vitamin D that disrupted calcium absorption through the intestine, and decreased calcemia increased parathyroid hormone levels with resulting bone effect. The manifestation of physiological aging is worsening eyesight, peripheral neuropathy, depression, worsening of physical condition, skin aging, sarcopenia and bone mineral loss. Senile osteoporosis, which is not caused by known risk factors for osteoporosis, does not appear to be a separate disease, but is part of the physiological process of aging. Treatment of senile osteoporosis should be focused on the control of secondary hyperparathyroidism by administration of vitamin D and calcium. The risk of fractures in the advanced age is determined by a large number of factors ranging from hazards in the home environment to frailty and poor balance.

scholarly journals USING QCT TO DETECT DRUG-INDUCED OSTEOPOROSIS IN PATIENTS WITH MENTAL DISORDERS

2019 ◽  
pp. 77-86
Author(s):  
N. I. Ananyeva ◽  
S. E. Likhonosova ◽  
N. G. Neznanov ◽  
G. E. Mazo ◽  
R. F. Nasyrova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mental Illness ◽  
Clinical Practice ◽  
High Risk ◽  
Mental Disorders ◽  
Laboratory Data ◽  
Cumulative Risk ◽  
Drug Induced ◽  
Illness Duration

In clinical practice, the assessment of the cumulative risk of drug-induced osteoporosis in patients with mental disorders is difficult because there are no algorithms to reveal patients with a high risk of antipsychotic-induced osteoporosis and BMD is not evaluated in patients with mental disorders. 95 patients aged from 21 to 60 years with a mental illness duration of at least 12 months on antipsychotics and anticonvulsants therapy were examined. 23 patients (24%) had shown a violation of BMD. There is a significant correlation between the number of risk factors and a decrease in BMD. However, additional study of pharmacogenetic and laboratory data on the risk of osteoporosis is required, which will make it possible to plan therapy more precisely, additionally prescribe drugs that regulate BMD in these categories of patients.

Risk assessment for severe hypocalcemia requiring hospitalization with denosumab.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 115-115 ◽  
Author(s):  
Karen A. Autio ◽  
Azeez Farooki ◽  
Ilya Glezerman ◽  
Amelia Chan ◽  
Hallie C. Barr ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Calcium Absorption ◽  
Advanced Disease ◽  
Vitamin D Insufficiency ◽  
Castration Resistant Prostate Cancer ◽  
Exact Test ◽  
Symptomatic Hypocalcemia ◽  
Potential Risk Factors ◽  
Clinical Risks

115 Background: Skeletal-related events (SRE) pose clinical risks to patients (pts) with metastatic castration-resistant prostate cancer (mCRPC) that can be mitigated with denosumab. Hypocalcemia is a side effect, however risk factors are not well described. Methods: An IRB waiver was obtained to review medical records for all mCRPC pts receiving denosumab at MSKCC between March-August 2011 for baseline labs, calcium (ca) and vitamin D nadirs, details of hospitalizations, concurrent therapies, and comorbidities. Comparisons between groups were made using Fisher’s exact test and the Wilcox rank sum test. Results: Nine of sixty pts (15%) treated with 1-2 doses of denosumab developed severe symptomatic hypocalcemia (median nadir 6.5 mg/dL) requiring hospitalization for intravenous (IV) ca replacement. Ca/Vitamin D was recommended to all pts. Ca recovered in 17 days in those who did return to baseline levels (n=5). However, four of nine (44%) pts required repeated hospitalizations for IV ca, never recovered to baseline ca levels, and died of advanced disease within 3 months. Median vitamin D 25-OH was 22.5 ng/ml for hospitalized pts, and PTH was 198 pg/ml at ca nadir. Conclusions: Denosumab was associated with severe hypocalcemia sufficient to require hospitalizations for IV ca replacement in 15% of pts with mCRPC. PSA, Ca, Alk Phos, and current chemotherapy were associated with severe hypocalcemia requiring hospitalization for IV ca. Clinicians are cautioned regarding potential risk factors including advanced disease, vitamin D insufficiency, and possibly comorbidities affecting calcium absorption. [Table: see text]

Therapeutic options in male osteoporosis

2013 ◽  
Vol 22 (04) ◽  
pp. 271-276 ◽  
Author(s):  
P. Farahmand ◽  
J. D. Ringe
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Public Health Problem ◽  
Male Osteoporosis ◽  
Individual Risk ◽  
Modes Of Action ◽  
Increased Risk ◽  
Study Results ◽  
Long Term Treatment ◽  
Male Patients

SummaryOsteoporosis in men is increasingly recognized as an important public health problem but affected patients are still under-diagnosed and -treated. As in women the diagnostic and therapeutic strategy has to be adapted to the individual case. In the practical management it is very important to detect possible causes of secondary osteoporosis, to explain the possibilities of basic therapy counteracting individual risk factors and communicate that osteoporosis is a chronic disease and adherence to a long-term treatment is crucial. In established severe osteoporosis a careful analgesic therapy is important to avoid further bone loss related to immobility. In elderly men with increased risk of falling insufficient Vitamin D supply or impaired activation of Vitamin D due to renal insufficiency must be taken into consideration. Specific medications available today for the treatment of male osteoporosis comprise among antiresorptive drugs the bis phosphonates alendronate, risedronate and zoledronic acid. Denosumab, the first biological therapy is approved for men with androgen deprivation therapy for prostate cancer. An important advantage of this potent antiresorptive drug is the increased adherence due to the comfortable application by sixmonthly subcutaneous injections. Study results from the 2-year multi-center randomized controlled ADAMO-Study will very soon allow the use of denosumab in all types of male osteoporosis. Teriparatide, the 34 N-terminal amino acid sequence of parathyroid hormone was approved for men with osteoporosis as an anabolic agent based on proven efficacy by different studies. Among drugs with other modes of action the D-hormone pro-drug alfacalcidol can be used in men alone or in combination with the advantage of pleiotropic effects on calcium absorption, parathyroids, bone and muscle. Recently also Strontium-ranelate was approved for male patients with the limitation to exclude men with clinical relevant cardiovascular risk factors. In general the possibilities to treat male osteoporosis have considerably improved during recent years. Today there is a choice of a spectrum of drugs from mild to strong potency with different modes of action on bone turnover to design strategies for individual male patients.

OCCULT MALABSORPTION CAUSING OSTEITIS FIBROSA CYSTICA

1962 ◽  
Vol 40 (4) ◽  
pp. 481-492
Author(s):  
J. G. Devlin ◽  
D. K. O'Donovan
Keyword(s):  
Vitamin D ◽  
Iron Absorption ◽  
Calcium Absorption ◽  
Calcium Balance ◽  
Gluten Free ◽  
Osteitis Fibrosa Cystica ◽  
Mucosal Atrophy ◽  
Cystic Changes ◽  
Calcium Malabsorption ◽  
Radiological Examinations

ABSTRACT A case is reported of intermittent hypercalcaemia, hypophosphataemia and severe skeletal rarefaction with cystic changes. An occult calcium malabsorption was found. Fat, triolein and iron absorption and radiological examinations were normal. There was gross intestinal mucosal atrophy. She was shown to be in a state of negative calcium balance and this was reversed by vitamin D. A gluten-free diet also improved calcium absorption. It is postulated that the patient had severe secondary hyperparathyroidism as the skeleton reverted to normal after six months of medical treatment.

Prevalence and risk factors of low vitamin D in Kano, Northwestern Nigeria

2018 ◽  
Author(s):  
Fakhraddeen Muhammad ◽  
Andrew Uloko ◽  
Ibrahim Gezawa ◽  
Adenike Enikuomehin
Keyword(s):  
Risk Factors ◽  
Vitamin D
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