High incidence of hypocalcemia and serum creatinine increase in patients with bone metastases treated with zoledronic acid

Monica Zuradelli, Giovanna Masci, Giuseppe Biancofiore, Giuseppe Gullo, Marta Scorsetti, Pierina Navarria, Flavio Tancioni, Marco Berlusconi, Laura Giordano, Armando Santoro

Research output: Contribution to journalArticle

Abstract

Background. Zoledronic acid belongs to the new generation of bisphosphonates with demonstrated clinical benefit for the treatment of bone metastases from different kinds of neoplasms. Hypocalcemia and serum creatinine elevation are expected adverse events during this therapy. The monitoring of serum calcium and creatinine is therefore recommended. The primary aim of this study was to establish the actual incidence of hypocalcemia and serum creatinine elevation during treatment with zoledronic acid. Skeletal-related events and side effects were also assessed. Methods. Serum creatinine and calcium levels were evaluated in 240 consecutive patients (83 males, 157 females; mean age, 62 years) with metastatic bone lesions from different solid tumors treated with zoledronic acid. Results. Overall, 93 of 240 patients (38.8%) developed hypocalcemia, which was grade (G)1 in 45 patients (48.4%), G2 in 37 patients (39.8%), G3 in 10 patients (10.8%), and G4 in one patient (1.1%). The median time to occurrence of hypocalcemia (any grade) was 2.3 months after the beginning of the treatment (range, 0-34.9 months). Increased serum creatinine was observed in 33 of 240 patients (13.7%), of whom 19 had G1 (57.6%), 11 had G2 (33.3%), and three had G3 (9.1%). The median time to serum creatinine increase (for any grade) was 4.7 months (range, 0-29.2 months). Conclusions. Our analysis shows a high incidence of hypocalcemia and increased serum creatinine level during treatment with zoledronic acid. These results strongly support the need for accurate monitoring of plasma calcium and creatinine levels.

Original languageEnglish
Pages (from-to)548-556
Number of pages9
JournalThe oncologist
Volume14
Issue number5
DOIs
Publication statusPublished - May 2009

Keywords

  • Bisphosphonates
  • Bone metastasis
  • Laboratory abnormalities
  • Zoledronic acid

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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