Hypocalcaemia after inpatient injectables for hip fracture patients: lessons learnt from an orthogeriatric rehab unit
Introduction: The Five Nations Consensus (2023) recommends inpatient intravenous zoledronate for secondary prevention following hip fracture.1 Denosumab is an alternative in patients who are unable to receive bisphosphonates. Post-injectable hypocalcaemia is a recognised side effect of either therap...
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| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-07-01
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| Series: | Clinical Medicine |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1470211825001277 |
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| Summary: | Introduction: The Five Nations Consensus (2023) recommends inpatient intravenous zoledronate for secondary prevention following hip fracture.1 Denosumab is an alternative in patients who are unable to receive bisphosphonates. Post-injectable hypocalcaemia is a recognised side effect of either therapy, with the incidence of severe hypocalcaemia reported at 2-3%.2,3 We have seen several of our own hypocalcaemia cases recently; thus, this audit was designed to explore any identifiable or reversible risk factors in our cohort of patients. Method: Electronic records of 72 discharges over a 3-month period were reviewed. Patient demographics, as well as admission serum calcium, creatinine clearance, PTH and vitamin D, were all recorded. Vitamin D, zoledronate and denosumab prescriptions were also reviewed, along with post-injectable serum calcium. Results: 62.5% (n=45) of patients received an inpatient injectable therapy. Zoledronate was preferred over denosumab (93.3% vs 6.7%).10 patients developed hypocalcaemia (22.2%). These patients were all either vitamin D replete or had received high dose, rapid vitamin D loading before the injectable was given. 2 patients developed severe hypocalcaemia, requiring intravenous calcium replacement; one patient had received denosumab and one zoledronate. Both had a normal serum calcium on admission, but CKD was present. Both had significantly raised serum PTH (>20 pmol/L) before receiving an injectable, indicating secondary hyperparathyroidism. Conclusion: 4.4% (n=2) of patients receiving an injectable therapy developed severe hypocalcaemia. This risk was likely to be higher when receiving denosumab compared with zoledronate (33.3% vs 2.4%). Secondary hyperparathyroidism (2̊° HPTH) was the biggest risk factor for developing severe hypocalcaemia post injectables on our unit.We would advocate that all orthogeriatric patients with CKD and/or vitamin D deficiency should have an admission serum PTH checked irrespective of serum calcium. If raised, clinicians should proceed to the use of injectable therapies for osteoporosis with caution, especially with denosumab. If an injectable is used in this cohort, patients should have more frequent measurement of their serum calcium to monitor for hypocalcaemia. |
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| ISSN: | 1470-2118 |