Denosumab-Induced Hypocalcemia after Billroth II Gastric Bypass Surgery
Hypocalcemia is a known risk following bariatric surgery and can contribute to the development of osteoporosis. Osteoporosis is commonly treated with denosumab, though denosumab can exacerbate underlying abnormalities in calcium homeostasis. We present the case of a 59-year-old female with severe hy...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Case Reports in Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2020/8833723 |
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| author | Abigail M. Schmucker Dina E. Green Philip M. Montemuro |
| author_facet | Abigail M. Schmucker Dina E. Green Philip M. Montemuro |
| author_sort | Abigail M. Schmucker |
| collection | DOAJ |
| description | Hypocalcemia is a known risk following bariatric surgery and can contribute to the development of osteoporosis. Osteoporosis is commonly treated with denosumab, though denosumab can exacerbate underlying abnormalities in calcium homeostasis. We present the case of a 59-year-old female with severe hypocalcemia who had been treated with denosumab for osteoporosis three months before and had Billroth II gastric bypass surgery 15 years before, for bariatric purposes. Intravenous calcium supplementation was used to correct the initial electrolyte abnormality, and the patient was able to maintain appropriate calcium levels on high doses of oral calcium before discharge. Denosumab-induced hypocalcemia has been previously reported in patients with predisposing conditions including chronic kidney disease, primary sclerosing cholangitis, Crohn’s disease, and a history of sleeve gastrectomy for marginal gastric ulcers. A few cases of hypocalcemia have been reported in patients with a history of bariatric surgery secondary to vitamin D deficiency, but this report is unique in demonstrating denosumab-induced hypocalcemia after bariatric surgery with normal vitamin D levels, suggesting a primary malabsorption of calcium. The risk of severe hypocalcemia should be considered before initiating denosumab to treat osteoporosis in patients with a history of bariatric surgery. If denosumab is initiated, serum calcium levels should be closely monitored, and patients should be educated about the importance of adherence to calcium supplementation. |
| format | Article |
| id | doaj-art-1e64818a37b744ff9135926221192596 |
| institution | Kabale University |
| issn | 2090-6501 2090-651X |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Endocrinology |
| spelling | doaj-art-1e64818a37b744ff91359262211925962025-02-03T05:53:53ZengWileyCase Reports in Endocrinology2090-65012090-651X2020-01-01202010.1155/2020/88337238833723Denosumab-Induced Hypocalcemia after Billroth II Gastric Bypass SurgeryAbigail M. Schmucker0Dina E. Green1Philip M. Montemuro2Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street, Philadelphia, PA 19107, USALankenau Medical Center, 100 East Lancaster Avenue, Wynnewood, PA 19096, USALankenau Medical Center, 100 East Lancaster Avenue, Wynnewood, PA 19096, USAHypocalcemia is a known risk following bariatric surgery and can contribute to the development of osteoporosis. Osteoporosis is commonly treated with denosumab, though denosumab can exacerbate underlying abnormalities in calcium homeostasis. We present the case of a 59-year-old female with severe hypocalcemia who had been treated with denosumab for osteoporosis three months before and had Billroth II gastric bypass surgery 15 years before, for bariatric purposes. Intravenous calcium supplementation was used to correct the initial electrolyte abnormality, and the patient was able to maintain appropriate calcium levels on high doses of oral calcium before discharge. Denosumab-induced hypocalcemia has been previously reported in patients with predisposing conditions including chronic kidney disease, primary sclerosing cholangitis, Crohn’s disease, and a history of sleeve gastrectomy for marginal gastric ulcers. A few cases of hypocalcemia have been reported in patients with a history of bariatric surgery secondary to vitamin D deficiency, but this report is unique in demonstrating denosumab-induced hypocalcemia after bariatric surgery with normal vitamin D levels, suggesting a primary malabsorption of calcium. The risk of severe hypocalcemia should be considered before initiating denosumab to treat osteoporosis in patients with a history of bariatric surgery. If denosumab is initiated, serum calcium levels should be closely monitored, and patients should be educated about the importance of adherence to calcium supplementation.http://dx.doi.org/10.1155/2020/8833723 |
| spellingShingle | Abigail M. Schmucker Dina E. Green Philip M. Montemuro Denosumab-Induced Hypocalcemia after Billroth II Gastric Bypass Surgery Case Reports in Endocrinology |
| title | Denosumab-Induced Hypocalcemia after Billroth II Gastric Bypass Surgery |
| title_full | Denosumab-Induced Hypocalcemia after Billroth II Gastric Bypass Surgery |
| title_fullStr | Denosumab-Induced Hypocalcemia after Billroth II Gastric Bypass Surgery |
| title_full_unstemmed | Denosumab-Induced Hypocalcemia after Billroth II Gastric Bypass Surgery |
| title_short | Denosumab-Induced Hypocalcemia after Billroth II Gastric Bypass Surgery |
| title_sort | denosumab induced hypocalcemia after billroth ii gastric bypass surgery |
| url | http://dx.doi.org/10.1155/2020/8833723 |
| work_keys_str_mv | AT abigailmschmucker denosumabinducedhypocalcemiaafterbillrothiigastricbypasssurgery AT dinaegreen denosumabinducedhypocalcemiaafterbillrothiigastricbypasssurgery AT philipmmontemuro denosumabinducedhypocalcemiaafterbillrothiigastricbypasssurgery |