{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:33:41Z","timestamp":1781649221509,"version":"3.54.5"},"reference-count":14,"publisher":"The Endocrine Society","issue":"7","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Denosumab-induced hypocalcemia is a well-recognized entity, especially in patients with renal impairment or vitamin D deficiency. Hungry bone syndrome (HBS), characterized by prolonged hypocalcemia and hypophosphatemia due to rapid skeletal remineralization, is classically seen post-parathyroidectomy and is rare in purely osteolytic malignancies such as multiple myeloma (MM). A 76-year-old man with newly diagnosed MM (extensive osteolytic skeletal involvement) developed severe, prolonged hypocalcemia following two doses of denosumab administered one month apart. Pre-denosumab evaluation showed elevated creatinine and calcium, sufficient vitamin D, and suppressed parathyroid hormone. One week after the second dose, he was found to have profound hypocalcemia, hypophosphatemia, hypomagnesemia, and QT interval prolongation. Despite aggressive oral calcium, calcitriol, and magnesium supplementation, hypocalcemia, hypophosphatemia, and hypomagnesemia persisted. Subsequent evaluation revealed secondary hyperparathyroidism and persistently elevated bone turnover markers (both formation and resorption). Low urinary calcium excretion supported the presence of a skeletal mineral sink. This case highlights an HBS-like state after denosumab-induced osteoclast inhibition in high-turnover osteolytic lesions of MM. Renal impairment and extensive skeletal involvement were predisposing factors. Persistence of elevated resorption marker suggests incomplete suppression of bone resorption due to secondary hyperparathyroidism and renal impairment. Close monitoring and anticipatory mineral supplementation are essential after denosumab in high-risk individuals.<\/jats:p>","DOI":"10.1210\/jcemcr\/luag137","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T11:29:21Z","timestamp":1777980561000},"source":"Crossref","is-referenced-by-count":1,"title":["Hungry bone syndrome-like state following denosumab in a patient with multiple myeloma"],"prefix":"10.1210","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9540-1613","authenticated-orcid":false,"given":"Nupoor","family":"Vaghasia","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Diabetes, Max Super Speciality Hospital, Saket , New Delhi 110017 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aditya","family":"Dutta","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes, Max Super Speciality Hospital, Saket , New Delhi 110017 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunal","family":"Rupwane","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes, Max Super Speciality Hospital, Saket , New Delhi 110017 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid","family":"Farooqui","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes, Max Super Speciality Hospital, Saket , New Delhi 110017 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ambrish","family":"Mithal","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes, Max Super Speciality Hospital, Saket , New Delhi 110017 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"issue":"3","key":"2026052009253639100_luag137-B1","doi-asserted-by":"crossref","first-page":"R45","DOI":"10.1530\/EJE-12-0528","article-title":"THERAPY OF ENDOCRINE DISEASE: hungry bone syndrome: still a challenge in the post-operative management of primary hyperparathyroidism: a systematic review of the literature","volume":"168","author":"Witteveen","year":"2013","journal-title":"Eur J Endocrinol"},{"issue":"2","key":"2026052009253639100_luag137-B2","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.surg.2017.09.008","article-title":"Is hungry bone syndrome a cause of postoperative hypocalcemia after total thyroidectomy in thyrotoxicosis? A prospective study with bone mineral density correlation","volume":"163","author":"Karunakaran","year":"2018","journal-title":"Surgery"},{"key":"2026052009253639100_luag137-B3","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2018-225039","article-title":"Hungry bone syndrome secondary to prostate cancer successfully treated with radium therapy","volume":"2018","author":"Garla","year":"2018","journal-title":"BMJ Case Rep"},{"issue":"2","key":"2026052009253639100_luag137-B4","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.jbo.2013.04.001","article-title":"Myeloma bone disease: pathophysiology and management","volume":"2","author":"Silbermann","year":"2013","journal-title":"J Bone Oncol"},{"issue":"8","key":"2026052009253639100_luag137-B5","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1093\/jjco\/hys088","article-title":"Efficacy and safety of denosumab for the treatment of bone metastases in patients with advanced cancer","volume":"42","author":"Kurata","year":"2012","journal-title":"Jpn J Clin Oncol"},{"issue":"5","key":"2026052009253639100_luag137-B6","article-title":"The calcium culprit: a case of denosumab-induced hypocalcemia","volume":"11","author":"Kalayanamitra","year":"2019","journal-title":"Cureus"},{"issue":"16","key":"2026052009253639100_luag137-B7","doi-asserted-by":"crossref","first-page":"3082","DOI":"10.1016\/j.ejca.2012.08.002","article-title":"Superiority of denosumab to zoledronic acid for prevention of skeletal-related events: a combined analysis of 3 pivotal, randomised, phase 3 trials","volume":"48","author":"Lipton","year":"2012","journal-title":"Eur J Cancer"},{"issue":"1","key":"2026052009253639100_luag137-B8","first-page":"e82","article-title":"Severe, prolonged, denosumab-induced hypocalcemia with recovery after 111 days of high-dose calcium supplementation","volume":"5","author":"McCaleb","year":"2019","journal-title":"AACE Clin Case Rep"},{"issue":"11","key":"2026052009253639100_luag137-B9","doi-asserted-by":"crossref","DOI":"10.3390\/cancers14112768","article-title":"Daratumumab improves bone turnover in relapsed\/refractory multiple myeloma; phase 2 study \u201cREBUILD.\u201d","volume":"14","author":"Terpos","year":"2022","journal-title":"Cancers (Basel)"},{"issue":"5","key":"2026052009253639100_luag137-B10","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1002\/cncr.28481","article-title":"The effects of bortezomib on bone disease in patients with multiple myeloma","volume":"120","author":"Mohty","year":"2014","journal-title":"Cancer"},{"issue":"7","key":"2026052009253639100_luag137-B11","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2022-250647","article-title":"Hungry bone syndrome like presentation following single-dose denosumab for hypercalcaemia secondary to sarcoidosis with IgA nephropathy","volume":"15","author":"Nachankar","year":"2022","journal-title":"BMJ Case Rep"},{"issue":"19","key":"2026052009253639100_luag137-B12","doi-asserted-by":"crossref","DOI":"10.3390\/jcm14197104","article-title":"Hungry bone syndrome after parathyroidectomy for secondary hyperparathyroidism: pathogenesis and contemporary clinical considerations","volume":"14","author":"Coman","year":"2025","journal-title":"J Clin Med"},{"issue":"Supplement_1","key":"2026052009253639100_luag137-B13","doi-asserted-by":"crossref","DOI":"10.1210\/jendso\/bvad114.518","article-title":"SAT221 a case of severe hypocalcemia after treatment of plasma cell leukemia","volume":"7","author":"Tabassum","year":"2023","journal-title":"J Endocr Soc"},{"issue":"1","key":"2026052009253639100_luag137-B14","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1186\/s13256-024-04478-3","article-title":"Recurrent severe hypocalcemia following chemotherapy regimen changes in advanced breast cancer: two case reports","volume":"18","author":"Yanase","year":"2024","journal-title":"J Med Case Rep"}],"container-title":["JCEM Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jcemcr\/article-pdf\/4\/7\/luag137\/68345528\/luag137.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcemcr\/article-pdf\/4\/7\/luag137\/68345528\/luag137.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T13:25:44Z","timestamp":1779283544000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcemcr\/article\/doi\/10.1210\/jcemcr\/luag137\/8688145"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,20]]},"references-count":14,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,5,20]]}},"URL":"https:\/\/doi.org\/10.1210\/jcemcr\/luag137","relation":{},"ISSN":["2755-1520"],"issn-type":[{"value":"2755-1520","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7]]},"published":{"date-parts":[[2026,5,20]]},"article-number":"luag137"}}