Hypocalcemia Risk of Denosumab Across the Spectrum of Kidney Disease: A Population-Based Cohort Study
Authors' conclusion
In this large population-based cohort, we found that the overall risk of hypocalcemia with new denosumab use was low but increased substantially in those with eGFR <15 mL/min/1.73 m2 .
Study context
- Population
- Adults >65 years with a new prescription for denosumab or a bisphosphonate, 2012–2020; results stratified by eGFR
- Participants
- 59,151 vs 56,847
- Exposure
- New denosumab vs new oral bisphosphonate use
- Denosumabn = 59,151
- Bisphosphonaten = 56,847reference
- Outcome
- Incidence of hypocalcemia
- Follow-up
- Within 180 days of drug dispensing
Methodological detailslinked health care databases (ICES), No information on over-the-counter vitamin D or calcium supplementation
- Linked health care databases (ICES)
- No information on over-the-counter vitamin D or calcium supplementation
Main finding
As reported in the abstract
Mild hypocalcemia (albumin corrected calcium <2.00 mmol/L), denosumab
0.6%
95% CI 0.6, 0.7
Severe hypocalcemia (<1.8 mmol/L), denosumab
0.2%
95% CI 0.2, 0.3
Mild hypocalcemia, denosumab, eGFR <15 or maintenance dialysis
24.1%
95% CI 18.1, 30.7
Severe hypocalcemia, denosumab, eGFR <15 or maintenance dialysis
14.9%
95% CI 10.1, 20.7
Observational data: associations, not effects.
Further findings
Mild hypocalcemia in new bisphosphonate users · within 180 days
- Overall
- 0.3% (95% CI 0.3, 0.3)
- eGFR <15 or maintenance dialysis
- 4.7% (95% CI 1.5, 10.8)
Predictors of hypocalcemia in eGFR <15 or dialysis (denosumab)
- Kidney function and baseline serum calcium were strong predictors of hypocalcemia
Serum calcium monitoring in denosumab users
- Serum calcium measured in year before prescription
- 29%
- Serum calcium checked within 180 days after prescription
- one-third
Original publication
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