Denosumab
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Rebound effect in form of hypophosphataemic osteomalacia: case report An adult woman [exact age at event onset not stated] exhibited rebound effect in form of hypophosphataemic osteomalacia following the discontinuation of denosumab for low bone mineral density [BMD; duration of treatment to reaction onset not stated] The woman, who had chronic kidney disease and type-1-diabetes mellitus, was receiving haemodialysis for the previous 7 years. Her medical history was also significant for treatment with aluminum hydroxide containing antacids for may years for stomach pain. At 4 years of treatment with aluminum hydroxide containing antacids, she suffered fractures of both heel bones, and a diagnosis of low BMD was considered. Therefore, her treatment was started with SC denosumab 60mg every 6 months. She received a total of four injections of denosumab (last injection in December 2016). One year after treatment, her lumbar spine BMD increased by 7%. However, BMD of distal forearm decreased by 16%. Therefore, she stopped the denosumab treatment. In August 2017, she suffered a bilateral femoral neck fracture after falling from a dialysis chair. In the following 6 months, she experienced multiple rib and scapular fractures. Laboratory tests revealed the following: phosphates 0.42 mmol/L, 25-OH-vitamin D 22 ng/mL and high levels of alkaline phosphatase and bone metabolites. Intact Parathyroid hormone level was found to be 12.1 pmol/L. Based on the examinations, she was diagnosed with hypo-phosphataemic osteomalacia secondary to rebound effect due to discontinuation of denosumab. The woman was started on high dose alfacalcidol and phosphate rich diet; however, she suffered a fracture in the right arm. Therefore, she started receiving zoledronic acid [outcome not stated]. Mazurenko S, et al. Severe rebound effect and multiple fractures after denosumab discontinuation in patient with chronic kidney disease stage 5. Bone Reports 13 (Suppl.): 100562 (plus poster) abstr. 266, Oct 2020. Available from: URL: http://doi.org/10.1016/j.bonr.2020.100562 [abstract] 803514999
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Reactions 14 Nov 2020 No. 1830
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