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While deprescribing is a key principle in this setting, routine discontinuation of calcium and vitamin D supplementation may be harmful in selected high-risk patients, particularly after recent antiresorptive therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 74-year-old woman with hormone receptor-positive metastatic breast cancer, extensive bone metastases and chronic kidney disease, was admitted to a German palliative care unit. Four weeks prior, she had received zoledronic acid, and calcium and vitamin D supplementation were discontinued on admission. She subsequently developed persistent nausea, vomiting and bronchospasm without classical neuromuscular signs, which were initially attributed to other causes. At a corrected calcium nadir of 0.95 mmol\/L intravenous calcium was started and symptoms resolved. Oral intake resumed and supplementation was restarted. She was discharged to hospice care and died nine months later.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>After recent antiresorptive therapy, especially in patients with additional risk factors such as renal impairment, hypocalcemia may present with atypical symptoms including nausea or bronchospasm. This case highlights a potential pitfall of deprescribing in palliative care and underscores the need for individualized decisions regarding calcium and vitamin D supplementation to prevent delayed diagnosis and avoidable symptom burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12904-026-02070-8","type":"journal-article","created":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T05:53:51Z","timestamp":1774072431000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Case report of severe hypocalcemia with atypical symptoms after zoledronic acid in palliative care: a deprescribing pitfall"],"prefix":"10.1186","volume":"25","author":[{"given":"Till","family":"Arnold","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Berner-Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Rudolph","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Bausewein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"R\u00e9mi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,21]]},"reference":[{"issue":"2","key":"2070_CR1","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1093\/ageing\/afaa159","volume":"50","author":"D Curtin","year":"2021","unstructured":"Curtin D, Gallagher P, O\u2019Mahony D. 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