{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T21:42:12Z","timestamp":1768254132609,"version":"3.49.0"},"reference-count":14,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T00:00:00Z","timestamp":1748304000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Osteoporosis and iron deficiency anaemia are common coexisting comorbidities in an ageing population. To facilitate timely administration of disease\u2010modifying therapy, denosumab and iron infusions are often given concurrently on the day of discharge from an inpatient admission following fracture. It is becoming increasingly recognised that close administration of both can result in profound hypocalcaemia and\/or hypophosphataemia due to disruption of calcium, phosphate and bone remodelling homeostasis. Our case series describes three cases of clinically significant, symptomatic hypocalcaemia in the setting of this potential drug\u2013drug interaction, with symptoms including atraumatic femoral fracture, subacute cognitive decline and non\u2010sustained ventricular tachycardia. While most previous case reports described hypocalcaemia in patients with advanced chronic kidney disease, two out of three of our cases had normal renal function, and one patient developed hypocalcaemia despite having calcium and cholecalciferol supplementation before and after denosumab administration. The optimal safe period between administration of the two medications has not been clearly established; one of our patients developed electrolyte disturbances despite having the medications 10\u2009weeks apart.<\/jats:p>","DOI":"10.1111\/imj.70091","type":"journal-article","created":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T13:53:45Z","timestamp":1748354025000},"page":"1028-1032","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Symptomatic hypocalcaemia after administration of denosumab and iron infusion in patients with normal and impaired renal function"],"prefix":"10.1111","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5872-5555","authenticated-orcid":false,"given":"Lai\u2010Ming Kathleen","family":"Pak","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Diabetes Alfred Health  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda","family":"Cox","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes Alfred Health  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leon A.","family":"Bach","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes Alfred Health  Melbourne Victoria Australia"},{"name":"School of Translational Medicine Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,5,27]]},"reference":[{"key":"e_1_2_3_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbo.2022.100416"},{"key":"e_1_2_3_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2021.116202"},{"key":"e_1_2_3_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-023-06926-0"},{"key":"e_1_2_3_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.4045"},{"key":"e_1_2_3_6_1","doi-asserted-by":"publisher","DOI":"10.2147\/TCRM.S243462"},{"key":"e_1_2_3_7_1","first-page":"781","article-title":"Severe hypocalcaemia following denosumab and iron infusion","volume":"27","author":"Cohen A","year":"2022","journal-title":"Nephrol Ther"},{"key":"e_1_2_3_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/imj.16156"},{"key":"e_1_2_3_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/imj.13001"},{"key":"e_1_2_3_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/jppr.1791"},{"key":"e_1_2_3_11_1","doi-asserted-by":"publisher","DOI":"10.1155\/2024\/8910092"},{"key":"e_1_2_3_12_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcemcr\/luae005"},{"key":"e_1_2_3_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.4804"},{"key":"e_1_2_3_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.14643"},{"key":"e_1_2_3_15_1","unstructured":"U.S. Food and Drug Administration.FDA adds Boxed Warning for increased risk of severe hypocalcemia in patients with advanced chronic kidney disease taking osteoporosis medicine Prolia (denosumab). U.S. Food and Drug Administration (updated 2025 Jan 1). Available from URL:https:\/\/www.fda.gov\/drugs\/drug-safety-and-availability\/fda-adds-boxed-warning-increased-risk-severe-hypocalcemia-patients-advanced-chronic-kidney-disease"}],"container-title":["Internal Medicine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.70091","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T16:05:36Z","timestamp":1749657936000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/imj.70091"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,27]]},"references-count":14,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1111\/imj.70091"],"URL":"https:\/\/doi.org\/10.1111\/imj.70091","archive":["Portico"],"relation":{},"ISSN":["1444-0903","1445-5994"],"issn-type":[{"value":"1444-0903","type":"print"},{"value":"1445-5994","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,27]]},"assertion":[{"value":"2024-11-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}