Frequency of Hypocalcaemia in Cancer Patients Receiving Zoledronic Acid for Bone Metastasis
DOI:
https://doi.org/10.70749/ijbr.v3i2.593Keywords:
Hypocalcemia, Zoledronic Acid, Bone Metastases, Cancer Therapy, Skeletal-related EventsAbstract
Background: The use of zoledronic acid for bone metastases in cancer patients is frequently accompanied by hypocalcemia, potentially compromising outcomes and quality of life. Despite its clinical significance, there is limited comprehensive data on the incidence and associated risk factors in this population. Objectives: To determine the frequency of hypocalcemia in cancer patients receiving zoledronic acid therapy for bone metastases and to assess its association with demographic and clinical variables. Study Settings: The research was undertaken at Shaukat Khanum Memorial Cancer Hospital & Research Center in Lahore, specifically in the Department of Medicine. Duration of Study: July 2024 to December 2024. Data Collection: A prospective observational cross-sectional study included 180 cancer patients aged 18–60 years with bone metastases receiving zoledronic acid therapy for at least three months. Corrected serum calcium levels were measured to define hypocalcemia (<8.5 mg/dl). Data were stratified by age, gender, BMI, and cancer type, and analyzed using SPSS version 21. Results: The prevalence of hypocalcemia was 6.7%. Hypocalcemia rates were comparable across age groups (6.6% in 18–50 years vs. 7.0% in >50 years; p = 0.926), genders (4.3% in males vs. 9.1% in females; p = 0.202), BMI categories (7.0% in BMI 18–25 vs. 6.4% in BMI >25; p = 0.873), and cancer types (breast cancer: 5.7%; lung cancer: 6.7%; prostate cancer: 6.4%; renal cell carcinoma: 9.1%; p = 0.936). Conclusion: Hypocalcemia is a rare but significant complication of zoledronic acid therapy. Routine calcium monitoring is essential for early detection and management. Future research should identify risk factors and improve supplementation.
Downloads
References
Wong, P. K., & Chen, W. (2024). Cancer survivorship and bone health. The Lancet Healthy Longevity, 5(3), e168-e169. https://doi.org/10.1016/s2666-7568(24)00022-9
Avancini, A., Benato, G., Borsati, A., Oliviero, L., Belluomini, L., Sposito, M., Tregnago, D., Trestini, I., Insolda, J., Zacchi, F., Fiorio, E., Schena, F., Milella, M., & Pilotto, S. (2022). Exercise and Bone Health in Cancer: Enemy or Ally? Cancers, 14(24), 6078. https://doi.org/10.3390/cancers14246078
Coleman, R. E., Croucher, P. I., Padhani, A. R., Clézardin, P., Chow, E., Fallon, M., Guise, T., Colangeli, S., Capanna, R., & Costa, L. (2020). Bone metastases. Nature Reviews Disease Primers, 6(1), 1–28. https://doi.org/10.1038/s41572-020-00216-3
Kannus, P. (2003). International osteoporosis foundation: The facts about osteoporosis and its impact. Lyon: International Osteoporosis Foundation.
Coleman, R. E., Major, P., Lipton, A., Brown, J. E., Lee, K., Smith, M., Saad, F., Zheng, M., Hei, Y. J., Seaman, J., & Cook, R. (2005). Predictive value of bone resorption and formation markers in cancer patients with bone metastases receiving the Bisphosphonate Zoledronic acid. Journal of Clinical Oncology, 23(22), 4925-4935. https://doi.org/10.1200/jco.2005.06.091
Rosen, L. S., Gordon, D., Tchekmedyian, N. S., Yanagihara, R., Hirsh, V., Krzakowski, M., Pawlicki, M., De Souza, P., Zheng, M., Urbanowitz, G., Reitsma, D., & Seaman, J. (2004). Long‐term efficacy and safety of zoledronic acid in the treatment of skeletal metastases in patients with nonsmall cell lung carcinoma and other solid tumors. Cancer, 100(12), 2613-2621. https://doi.org/10.1002/cncr.20308
Saad, F., Gleason, D. M., Murray, R., Tchekmedyian, S., Venner, P., Lacombe, L., Chin, J. L., Vinholes, J. J., Goas, J. A., & Zheng, M. (2004). Long-term efficacy of Zoledronic acid for the prevention of skeletal complications in patients with metastatic hormone-refractory prostate cancer. JNCI Journal of the National Cancer Institute, 96(11), 879-882. https://doi.org/10.1093/jnci/djh141
Polascik, T. (2008). Zoledronic acid in the management of metastatic bone disease. Therapeutics and Clinical Risk Management, 4, 261-268. https://doi.org/10.2147/tcrm.s2707
Michaelson, M. D., Lee, H., Kaufman, D. S., Kantoff, P. W., Finkelstein, J., & Smith, M. R. (2006). Annual zoledronic acid to prevent gonadotropin-releasing hormone agonist-induced bone loss in men with prostate cancer: A randomized placebo-controlled trial. Journal of Clinical Oncology, 24(18_suppl), 4515-4515. https://doi.org/10.1200/jco.2006.24.18_suppl.4515
Nasser, S. M., Sahal, A., Hamad, A., & Elazzazy, S. (2019). Effect of denosumab versus zoledronic acid on calcium levels in cancer patients with bone metastasis: A retrospective cohort study. Journal of Oncology Pharmacy Practice, 25(8), 1846-1852. https://doi.org/10.1177/1078155218820927
White, P. S., Dennis, M., Jones, E. A., Weinberg, J. M., & Sarosiek, S. (2020). Risk factors for development of Hypocalcemia in patients with cancer treated with bone-modifying agents. Journal of the National Comprehensive Cancer Network, 18(4), 420-427. https://doi.org/10.6004/jnccn.2019.7370
Chennuru, S., Koduri, J., & Baumann, M. A. (2008). Risk factors for symptomatic hypocalcaemia complicating treatment with zoledronic acid. Internal Medicine Journal, 38(8), 635-637. https://doi.org/10.1111/j.1445-5994.2007.01580.x
Al Elq, A. H. (2013). Symptomatic Hypocalcemia Associated with Zoledronic Acid Treatment for Osteoporosis: A Case Report. Oman Medical Journal, 28(2). https://doi.org/10.5001/omj.2013.42
Body, J., Von Moos, R., Niepel, D., & Tombal, B. (2018). Hypocalcaemia in patients with prostate cancer treated with a bisphosphonate or denosumab: Prevention supports treatment completion. BMC Urology, 18(1). https://doi.org/10.1186/s12894-018-0393-9
Committee of Full‐cycle Standardized Management of Bone Health in Breast Cancer Patients. (2024). Clinical practice guidelines for full‐cycle standardized management of bone health in breast cancer patients. Cancer Innovation, 3(1), e111. https://doi.org/10.1002/cai2.111
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Indus Journal of Bioscience Research
This work is licensed under a Creative Commons Attribution 4.0 International License.
