title: Symptomatic hypocalcaemia and renal impairment associated with bisphosphonate treatment in patients with multiple myeloma.
abstract: We report three cases of severe hypocalcaemia associated with i.v. bisphosphonate treatment in patients with multiple myeloma. All patients had symptomatic hypocalcaemia, including a tonic-clonic seizure and tachyarrhythmia in one case. Two cases were associated with the development of acute renal failure, whereas the third patient had pre-existing renal impairment. We recommend that bisphosphonates be used with caution in patients with myeloma and renal impairment, that vitamin D deficiency be corrected prior to treatment (to reduce the risk of hypocalcaemia) and that serum calcium and renal function be monitored during treatment.
authors.affiliation: Department of Endocrinology and Diabetes, Royal Perth Hospital, Perth, Western Australia, Australia. david.henley@health.wa.gov.au
authors.forename: D
authors.initials: D
authors.lastname: Henley
authors.forename: J
authors.initials: J
authors.lastname: Kaye
authors.forename: J
authors.initials: J
authors.lastname: Walsh
authors.forename: G
authors.initials: G
authors.lastname: Cull
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced; D000368:Aged; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D002117:Calcitriol / Q000627:therapeutic use; D002119:Calcium Carbonate / Q000627:therapeutic use; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy; D007093:Imidazoles / Q000009:adverse effects* / Q000627:therapeutic use; D007275:Injections, Intravenous; D008275:Magnesium Deficiency / Q000097:blood; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy*; D000077268:Pamidronate; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D002117:Calcitriol; D002119:Calcium Carbonate; D000077268:Pamidronate