Dramatic Elevation inParathyroid Hormone after Denosumab Administration in a Woman with Scleroderma

doi:10.13188/2334-2846.1000031

Abstract

Denosumab (Prolia), an injectable human monoclonal antibody with affinity for nuclear factor-kappa ligand (RANKL), is approved for the treatment of osteoporosis in postmenopausal women and men at high risk for fracture, or patients who have failed or are intolerant of ther treatments. There have been case reports of denosumab leading to elevated parathyroid hormone (PTH) among patients with severe renal impairment, defined as creatinine clearances under 30 mL/min or on dialysis, which is the level at which the manufacturer suggests monitoring for hypocalcemia. We report a case of a marked increase in PTH in a woman with suspected malabsorption due to scleroderma, without severe renal impairment, whose intractable diarrhea limited her treatment options.

Highlights

Denosumab (Prolia), an injectable human monoclonal antibody with affinity for nuclear factor-kappa ligand (RANKL), is approved for the treatment of osteoporosis in postmenopausal women and men at high risk for fracture
Denosumab administration has been linked to elevations in parathyroid hormone (PTH) among patients with severe renal impairment, defined as creatinine clearances (CrCl) under 30 mL/min or on dialysis, which is the level at which the manufacturer suggests monitoring for hypocalcemia [2,3]
We report a case of a marked increase in PTH in a woman with scleroderma without severe renal impairment, whose intractable diarrhea limited her treatment options

Summary

Introduction

Denosumab (Prolia), an injectable human monoclonal antibody with affinity for nuclear factor-kappa ligand (RANKL), is approved for the treatment of osteoporosis in postmenopausal women and men at high risk for fracture. Denosumab administration has been linked to elevations in parathyroid hormone (PTH) among patients with severe renal impairment, defined as creatinine clearances (CrCl) under 30 mL/min or on dialysis, which is the level at which the manufacturer suggests monitoring for hypocalcemia [2,3]. We report a case of a marked increase in PTH in a woman with scleroderma without severe renal impairment, whose intractable diarrhea limited her treatment options.

Results

Conclusion