Severe hypocalcaemia after being given intravenous bisphosphonate

doi:10.1136/bmj.328.7435.335

BMJ 2004;328:335-336 (7 February), doi:10.1136/bmj.328.7435.335

Clinical review

Lesson of the week

Severe hypocalcaemia after being given intravenous bisphosphonate

Rajesh Peter, senior house officer¹, Vinita Mishra, specialist registrar¹, William D Fraser, professor¹

¹ Department of Clinical Chemistry, Royal Liverpool University Hospital, Liverpool L69 3GA

Correspondence to: W D Fraser w.d.fraser@liv.ac.uk

The first 150 words of the full text of this article appear below.

Introduction

Bisphosphonates are increasingly used to treat metabolic bonedisease and as prophylaxis against metastatic bone cancer.^1
2Zoledronic acid is a new intravenous bisphosphonate licensedto treat hypercalcaemia of malignancy, but it has been usedoff licence as prophylaxis for metastatic cancer, bone pain,treatment of osteoporosis, and Paget's disease of the bone.Zoledronic acid is 100 to 1000 times more potent than disodiumpamidronate or oral alendronic acid, risedronate sodium, sodiumclodronate, or disodium etidronate. A randomised controlledtrial found that zoledronic acid is more effective than disodiumpamidronate in treating hypercalcaemia of malignancy.³ Zoledronicacid does not cause the gastrointestinal side effects associatedwith oral bisphosphonates, but increased potency carries a higherrisk of hypocalcaemia. We have recent experience of patientsbecoming hypocalcaemic after doctors gave intravenous bisphosphonates.

Case reports

A 49 year old man with transitional cell carcinoma of the bladderreceived chemotherapy with cisplatin, methotrexate, and vinblastineafter resection . . . [Full text of this article]

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