Clinical Use of Denosumab for Refractory Hypercalcemia: A Retrospective Case Series
https://doi.org/10.15605/jafes.041.S1
- Author:
Mohammad Amirul Shahril
1
;
Florence Hui Sieng Tan
2
;
Ee Wen Loh
2
;
Pei Lin Chan
2
;
Sing Yee Sim
1
Author Information
1. Endocrine Unit, Department of Medicine, Sarawak General Hospital;Universiti Malaysia Sarawak (UNIMAS)
2. Endocrine Unit, Department of Medicine, Sarawak General Hospital
- Publication Type:Journal Article
- MeSH:
Denosumab;
Hypercalcemia;
Retrospective Studies
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):71-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Severe hypercalcemia is most commonly caused by primary
hyperparathyroidism (PHPT) and malignancy. While
standard therapies are effective in most cases, a subset of
patients have persistent or refractory hypercalcemia. We
present a retrospective case series detailing the clinical
characteristics, biochemistry, and outcomes of patients
treated with denosumab for hypercalcemia.
Cases:Seven patients with severe hypercalcemia were identified,
comprising five with PHPT and two with malignancyassociated hypercalcemia. The mean age was 70.4 years
(range 55–86), with 71% female (n = 5) and 29% male (n
= 2). Baseline corrected calcium ranged from 2.92 to 4.59
mmol/L, with a mean of 3.26 mmol/L. In the PHPT cohort,
parathyroid hormone (PTH) levels were significantly
elevated (16.7–168 pmol/L), while malignancy patients had
suppressed PTH (0.6 and 0.9 pmol/L).
Prior to denosumab, 4/7 patients (57%) received bisphosphonates, 3/7 (43%) received calcitonin, and 1/7 (14%) was
treated with cinacalcet. Denosumab resulted in a mean
reduction in corrected calcium of 0.22 mmol/L from 3.26
to 3.03 mmol/L.
Biochemical response was observed in 5/7 patients (71%).
Of these, 3 patients (43%) achieved normocalcemia,
while 2 patients (29%) demonstrated a partial response.
The remaining 2/7 patients (29%) showed no significant
improvement in calcium levels. Among responders, the
mean time to calcium reduction to <3.0 mmol/L was 27 days
(range 7–47). Repeat dosing was required in the majority
of patients, with a mean of 1.7 doses per patient (range
1–4), indicating variability in both onset and durability
of response. Among patients with PHPT, four underwent
parathyroidectomy, and one declined surgery. Both patients
with malignancy were managed nonsurgically.
Conclusion:Denosumab achieved normocalcemia in 43% of patients,
with additional partial responses. Its effects were variable,
with delayed response and frequent need for repeat dosing,
supporting its role as an adjunctive or bridging therapy
rather than as a definitive treatment.
- Full text:2026080317241528664EP_A094.pdf
