Format

Send to

Choose Destination
See comment in PubMed Commons below
Support Care Cancer. 2017 Jan 12. doi: 10.1007/s00520-016-3543-1. [Epub ahead of print]

Hypercalcaemia and hypocalcaemia: finding the balance.

Author information

  • 1Department of Medicine (K1), CHU Brugmann (Universit√© Libre de Bruxelles), Place Van Gehuchten, 1020, Brussels, Belgium. Jean-jacques.BODY@chu-brugmann.be.
  • 2Amgen (Europe) GmbH, Vienna, Austria.
  • 3Department of Oncology, Policlinico Universitario Campus Bio-Medico, Rome, Italy.

Abstract

CALCIUM METABOLISM IN CANCER AND HYPERCALCAEMIA OF MALIGNANCY:

The balance between bone formation and resorption may be disrupted in patients with cancer, leading either to increased bone resorption, calcium release, and possibly hypercalcaemia, or to increased bone formation, sequestration of calcium, and possibly hypocalcaemia. In adults, hypercalcaemia of malignancy is most common in patients with tumours that produce factors that induce osteoclast activation and enhance bone resorption. Impaired renal function and increased renal tubular calcium resorption may further affect calcium levels.

TREATMENT OF HYPERCALCAEMIA OF MALIGNANCY:

Inhibitors of bone resorption, first the bisphosphonates and, later, denosumab, have been shown to be effective in hypercalcaemia treatment. Bisphosphonates (which are administered intravenously) are approved for hypercalcaemia of malignancy and are the current mainstay of treatment, whereas denosumab (which is administered subcutaneously) may offer an option for patients who do not respond to bisphosphonates or suffer from renal insufficiency.

HYPOCALCAEMIA:

TREATMENT AND PREVENTION: Hypocalcaemia is most common in patients with prostate cancer and osteoblastic bone metastases, but can occur in patients with a variety of tumour types who are receiving inhibitors of bone resorption. While patients often respond to calcium and vitamin D supplementation, prevention should be the aim; at-risk patients should be identified before starting treatment with inhibitors of bone resorption, be closely monitored during at least the first few months of treatment, and receive concomitant calcium and vitamin D supplementation unless hypercalcaemia is present.

CONCLUSION:

Both hypercalcaemia and hypocalcaemia can be serious if left untreated. It is therefore important that patients with cancer are closely monitored and receive adequate prevention and treatment measures to maintain normal blood calcium levels.

KEYWORDS:

Bisphosphonates; Denosumab; Hypercalcaemia; Hypercalcaemia of malignancy; Hypocalcaemia

PMID:
28078478
DOI:
10.1007/s00520-016-3543-1
[PubMed - as supplied by publisher]

Publication Types

Publication Types

PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Springer
    Loading ...
    Support Center