ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2026
Hypocalcemia following denosumab in osteoporosis: Incidence and risk factors in a Saudi cohort.
Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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- Updated perspectives on vitamin D deficiency, screening, supplementation and clinical guidance.Cardiovascular diabetology. Endocrinology reports · 2026Review
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Abstract
Denosumab-associated hypocalcemia is common in real-world settings. In this Saudi cohort, 21.1% developed hypocalcemia, with diuretic use and vitamin D deficiency as key predictors. Findings highlight that individualized risk assessment and monitoring may enhance the safety of osteoporosis treatment.
backgroundDenosumab, a widely used antiresorptive agent for osteoporosis, has demonstrated significant benefits in reducing fracture risk. However, hypocalcemia is a recognized adverse effect, with real-world data suggesting higher incidence rates than those reported in clinical trials. This study explores the incidence, severity, and predictors of denosumab-associated hypocalcemia in a Saudi cohort.
methodsA retrospective analysis was conducted at a tertiary care hospital, involving 303 Saudi adults with osteoporosis who received denosumab. The study evaluated changes in calcium levels, incidence of hypocalcemia, and potential risk factors, including vitamin D status, renal function, and medication use. Multivariate logistic regression identified predictors of hypocalcemia.
resultsHypocalcemia occurred in 21.1% of patients, with 71.9% experiencing mild (grade 1) hypocalcemia. Most cases were asymptomatic (73.4%), with tingling and muscle aches reported in a minority of patients. Diuretic use emerged as a significant predictor (aOR 3.44, p = 0.008). Vitamin D deficiency was strongly associated with severe hypocalcemia (grade 3). Despite adherence to standard calcium and vitamin D supplementation, a substantial proportion of patients developed hypocalcemia, underscoring the need for individualized monitoring.
conclusionHypocalcemia following denosumab is common in real-world practice, particularly in patients on diuretics or with low vitamin D levels. Clinicians should consider comprehensive pre-treatment risk assessment and tailored monitoring strategies to mitigate adverse outcomes in osteoporosis management.
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