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Symptomatic hypocalcaemia and renal impairment associated with bisphosphonate treatment in patients with multiple myeloma

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We report three cases of severe hypocalcaemia associated with i.v. bisphosphonate treatment in patients with multiple myeloma. All patients had symptomatic hypocalcaemia, including a tonic-clonic seizure and tachyarrhythmia in one case. Two cases were associated with the development of acute renal failure, whereas the third patient had pre-existing renal impairment. We recommend that bisphosphonates be used with caution in patients with myeloma and renal impairment, that vitamin D deficiency be corrected prior to treatment (to reduce the risk of hypocalcaemia) and that serum calcium and renal function be monitored during treatment. (Intern Med J 2005; 35: 726–728)

Keywords: bisphosphonate; hypocalcaemia; multiple myeloma; pamidronate; zoledronate

Document Type: Research Article


Affiliations: 1: Department of Endocrinology and Diabetes, Royal Perth Hospital 2: Endocrinology and Diabetes 3: Haematology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

Publication date: December 1, 2005


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