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Denosumab-induced hypocalcaemia in metastatic gastric cancer
  1. Craig Gouldthorpe1,
  2. Richard Quinton2 and
  3. Donna Wakefield3
  1. 1Palliative Medicine, Marie Curie Hospice Newcastle upon Tyne, Newcastle upon Tyne, UK
  2. 2Endocrinology, Leazes Wing, Royal Victoria Infirmary, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
  3. 3Palliative Medicine, North Tees and Hartlepool NHS Foundation Trust, Stockton-Upon-Tees, UK
  1. Correspondence to Dr Craig Gouldthorpe, Palliative Medicine, Marie Curie Hospice Newcastle upon Tyne, Newcastle upon Tyne NE4 6SS, UK; cgouldthorpe{at}


Hypocalcaemia in malignancy is infrequently reported and the underlying cause is often multifactorial. Denosumab, an antiresorptive medication, can be used to treat a number of cancer-related complications including hypercalcaemia, metastatic bone pain and to reduce fracture-events. We present a case of a hospice inpatient with profound and recurring hypocalcaemia following a single denosumab infusion which required repeated hospitalisation, for intravenous calcium, alongside a prolonged course of vitamin D and electrolyte replacement. The case highlights the risk of hypocalcaemia with denosumab use, together with the need to identify and treat vitamin D deficiency in both the prevention and management of such a complication.

  • gastrointestinal (upper)
  • drug administration
  • hospice care
  • pharmacology
  • pain

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  • Twitter @cgouldt, @DonnaWakefield_

  • Contributors Literature review was done by CG and DW. Original article was written by CG with editorial input for final manuscript from DW and RQ. Article was submitted by CG. All authors were involved in the care of the patient. CG was responsible for the overall content as guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.