Acute hypocalcaemia following denosumab in heart and lung transplant patients with osteoporosis

• Published in: Internal medicine journal 2018-06, Vol.48 (6), p.681-687
• Main Authors: Shrosbree, Julia E., Elder, Grahame J., Eisman, John A., Center, Jacqueline R.
• Format: Article
• Language: English
• Subjects: 25-Hydroxyvitamin D; Calcium; Calcium (blood); denosumab; Glomerular filtration rate; Heart; Heart transplantation; hypocalcaemia; Hypocalcemia; Immunotherapy; Kidney transplantation; Lung transplantation; Monoclonal antibodies; Osteoporosis; Prednisone; transplantation
• ISSN: 1444-0903; 1445-5994
• DOI: 10.1111/imj.13744

Background Osteoporosis is highly prevalent in the heart and lung transplant population. Given high rates of concurrent renal impairment, there is increasing use of denosumab in this population. However, denosumab may be associated with hypocalcaemia, particularly in patients with chronic kidney disease (CKD). Aim To explore the risk of hypocalcaemia in a heart and lung transplant cohort prescribed denosumab for osteoporosis. Methods We performed a retrospective database review of all surviving heart and lung transplant patients who had received denosumab for osteoporosis between January 2012 and November 2015. We assessed the rates of hypocalcaemia in this cohort and collected baseline clinical data to determine associated factors. Results Ten patients received denosumab and had laboratory results available within 3 months of the dose. Of these, three patients developed severe (grade 4) hypocalcaemia, while two patients developed mild (grade 1) hypocalcaemia. In comparison to the five patients who remained normocalcaemic, patients with hypocalcaemia had significantly lower baseline mean estimated glomerular filtration rate but similar baseline mean corrected serum calcium. Unexpectedly, patients developing hypocalcaemia had non‐significantly higher levels of 25‐hydroxyvitamin D and lower baseline doses of prednisone. Conclusions In heart and lung transplant patients, denosumab should be used judiciously in patients with advanced renal disease due to the risk of hypocalcaemia.