Metastatic cancer hypercalcemia, Metastatic cancer hypercalcemia

Bisphosphonates may interfere with diagnostic imaging agents such as technetiumm-diphosphonate in bone scans. Adverse Reactions The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. The fractures include subtrochanteric femur bone just below the hip joint and diaphyseal femur long segment of the thigh bone.

Metastatic cancer hypercalcemia

Some patients experience prodromal pain weeks or months before the fracture occurs. It is unclear if bisphosphonate therapy is the cause for these fractures; atypical femur fractures have also been reported in patients not taking bisphosphonates, and in patients receiving glucocorticoids.

Patients presenting with thigh or groin pain with a history of receiving bisphosphonates should be evaluated for femur fracture.

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Consider interrupting bisphosphonate therapy in patients who develop a femoral shaft fracture; assess for fracture in the contralateral limb. The onset of pain ranged from a single day to several months.

Consider discontinuing therapy in patients who experience severe symptoms; symptoms usually resolve upon discontinuation. Some patients experienced recurrence when rechallenged with same drug or another bisphosphonate; avoid use in patients with a history of these symptoms in association with bisphosphonate therapy.

Rare cases of symptomatic hypocalcemia, including tetany, have been reported. Known risk factors for MRONJ include invasive dental procedures eg, tooth extraction, dental implants, boney surgerycancer diagnosis, concomitant therapy eg, chemotherapy, corticosteroids, angiogenesis inhibitorspoor metastatic cancer hypercalcemia hygiene, ill-fitting dentures, and comorbid disorders anemia, coagulopathy, infection, preexisting dental or periodontal disease.

According to a position paper by the American Association of Maxillofacial Surgeons AAOMSMRONJ has been associated with bisphosphonates and other antiresorptive agents denosumaband antiangiogenic agents eg, bevacizumab, sunitinib used for the treatment of osteoporosis or malignancy; risk is significantly higher in cancer patients receiving antiresorptive therapy compared to patients receiving osteoporosis treatment regardless of medication used or dosing schedule.


MRONJ risk is also increased with monthly IV antiresorptive therapy compared to the minimal risk associated with oral bisphosphonate use, although risk appears to increase with oral bisphosphonates when duration of therapy exceeds 4 years. The AAOMS suggests that if medically permissible, initiation of IV bisphosphonates for cancer therapy should be delayed until optimal dental health is attained if extractions are required, antiresorptive therapy should delayed until the extraction site has mucosalized or until after adequate osseous healing.

Once IV bisphosphonate therapy is initiated for oncologic disease, procedures that involve direct osseous injury and placement of dental implants should be avoided. Initial or single doses have been associated with renal deterioration, progressing to renal failure and dialysis.

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Glomerulosclerosis focal segmental with or without nephrotic syndrome has also been reported. Withhold pamidronate treatment until renal function returns to baseline in patients with evidence of renal deterioration. The guidelines recommend initiating a BMA denosumab, pamidronate, zoledronic acid in patients with metastatic breast cancer to the bone. The optimal duration of BMA therapy is not defined; however, the guidelines recommend continuing BMA therapy indefinitely.

Bisphosphonate pamidronate or zoledronic acid therapy should be initiated in patients with radiographic or imaging evidence of lytic bone disease.

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Bisphosphonates may also be considered in patients with pain secondary to osteolytic disease and as adjunct therapy in patients receiving other interventions for fractures or impending fractures. The guidelines support utilizing IV bisphosphonates in patients with multiple myeloma and osteopenia osteoporosis but no radiographic evidence of lytic bone disease. Bisphosphonates are not recommended in patients with solitary plasmacytoma, smoldering asymptomatic or indolent myeloma with osteopenia in the absence of lytic bone disease.

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Bisphosphonates are also not recommended in monoclonal gammopathy of undetermined significance, unless osteopenia osteoporosis also is present. After 2 years, consider discontinuing in responsive and stable patients, and reinitiate upon relapse if a new-onset skeletal-related event occurs.

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The ASCO guidelines are in alignment with the prescribing information for dosing, renal dose adjustments, infusion times, metastatic cancer hypercalcemia and management of osteonecrosis of the jaw, and monitoring of laboratory parameter recommendations. Pamidronate may be reinitiated at a dose not to exceed 90 mg every 4 weeks with a longer infusion time of at least 4 hours. Evaluate serum creatinine prior to each treatment. For the treatment of bone metastases, use is not recommended in patients with severe renal impairment.

With indications other than metastatic cancer hypercalcemia metastases, use clinical judgment to determine if benefits outweigh potential risks in patients with renal impairment. Monitoring Parameters Serum creatinine prior to each treatment ; serum electrolytes, including metastatic cancer hypercalcemia, phosphate, magnesium, and potassium; CBC with differential; monitor for hypocalcemia for at least 2 weeks after therapy; metastatic cancer hypercalcemia exam and preventive dentistry prior metastatic cancer hypercalcemia therapy for patients at risk of osteonecrosis, including all patients with cancer; patients with pre-existing anemia, leukopenia, or thrombocytopenia should be closely monitored during ce inseamna anemie first 2 weeks of treatment; in addition, monitor urine albumin every 3 to 6 months in patients with multiple myeloma.

Multiple myeloma: Monitor serum creatinine prior to each doseserum calcium regularly ; vitamin D levels intermittentlyspot urine sample for albuminuria every 3 to 6 months; for unexplained albuminuria, obtain hour urine collection to assess urinary albumin; reassess every metastatic cancer hypercalcemia metastatic cancer hypercalcemia 4 weeks with hour urine collection for total protein and urine protein electrophoresis until renal function returns to baseline ASCO [Anderson ].

Paget disease: Serum total alkaline phosphatase at 6 to 12 weeks for initial response to treatment when bone turnover will have shown a substantial decline and potentially at 6 months maximal suppression of high bone turnover ; following treatment completion, monitor at ~6 to month intervals Endocrine Society [Singer ] ; monitoring more specific biochemical markers of bone turnover eg, serum P1NP, NTX, serum beta-CTx is generally only warranted in patients with Paget disease who have abnormal liver or biliary tract function or when early assessment of response to treatment is needed eg, spinal compression, very active disease Endocrine Society [Singer ] ; serum calcium and 25 OH D; phosphorus and magnesium; symptoms of hypocalcemia, pain posttreatment pain may not strictly correlate with increased biochemical markers [Ralston ] Prostate cancer: Androgen deprivation therapy ADT -associated osteoporosis: Monitor BMD every 18 to 24 months IOF [Cianferotti ].

#16 - Pathological Calcification - Dystrophic Calcification, metastatic calcification, hypercalcemia

Reproductive Considerations Bisphosphonates are incorporated into the bone matrix and gradually released over time. Because exposure prior to pregnancy may theoretically increase the risk of fetal harm, most sources recommend discontinuing bisphosphonate therapy in females of reproductive potential as early as possible prior to a planned pregnancy.

Use in cum se afișează viermi la oameni females should be reserved for special circumstances when rapid bone loss is occurring; a bisphosphonate with the shortest half-life should then be used Bhalla ; Pereira ; Stathopoulos Pregnancy Considerations It is not known if bisphosphonates cross the placenta, but based on their lower molecular weight, fetal exposure is expected Djokanovic ; Stathopoulos Metastatic cancer hypercalcemia related to the use of pamidronate in pregnancy is available from case reports and small retrospective studies Baretić ; Green ; Koren ; Levy ; Stathopoulos Bisphosphonates are incorporated metastatic cancer hypercalcemia the bone matrix and gradually released over time.

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The amount available in the systemic circulation varies by drug, dose, and duration of therapy. Theoretically, there may be a risk of fetal harm when pregnancy follows the completion of therapy hypocalcemia, low birth weight, and decreased gestation have been observed in some case reports ; however, available data have not shown that exposure to bisphosphonates during pregnancy significantly increases the risk of adverse fetal events Djokanovic ; Green ; Levy ; Machairiotis ; Sokal ; Stathopoulos Exposed infants should be monitored for hypocalcemia after birth Djokanovic ; Stathopoulos Patient Education What is this drug used for?

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