Magnesium Homeostasis

Khan, Aliya; Sbayi, Asiya; Schlingmann, Karl Peter

doi:10.1002/9781119266594.ch23

Cited by 3 publications

(5 citation statements)

References 46 publications

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“…In our study, we included measurements of magnesium and phosphate; both minerals are tightly connected to the calcium balance [ 21 , 22 ]. Low pre-injection values of magnesium or phosphate imposed a substantially increased risk of post-injection hypocalcemia.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of denosumab-induced hypocalcemia: a retrospective observational study of patients routinely monitored with ionized calcium post-injection

Spångeus,

Rydetun,

Woisetschläger

2023

Osteoporos Int

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Summary We assessed the prevalence of hypocalcemia after denosumab injections in a real-world cohort routinely monitored for calcium during up to 7.5 years of treatment. Among 1096 injections in 242 patients, 6.3% resulted in hypocalcemia, and was independent of the injection number. Severe hypocalcemia was rare (1%). Purpose To assess the prevalence of and risk factors for hypocalcemia after administration of denosumab in a patient cohort routinely monitored for ionized calcium after each dose. Methods In this retrospective observational study, we analyzed denosumab-induced hypocalcemia in a real-world cohort who were routinely followed up with ionized calcium pre- and post-injection (within 31 days after injection) during the period 2011 to 2020. Results In total, we included data from 1096 denosumab injections in 242 individuals (1–15 injections per patient). The mean age for the first injection was 74 ± 10 years, and 88% were female. Post-injection hypocalcemia occurred after 6.3% of all injections (4.6% mild, 0.6% moderate, and 1.1% severe) and was independent of the number of injections (rate of hypocalcemia varied from 3–8%). Risk factors for hypocalcemia were male sex, severe renal failure, pre-injection hypocalcemia, hypomagnesemia, hypophosphatemia, and vitamin D insufficiency. Furthermore, older age was not associated with an increased hypocalcemia risk. Conclusions Denosumab-induced hypocalcemia is a prevalent adverse event, which occurs independently of the number of injections. However, severe hypocalcemia is a rare occurrence, and severe renal failure and nutritional status appear to be important predictive factors. Magnesium and phosphate might add value in the pre-injection risk assessment; however, this observation needs to be confirmed in larger cohorts. Supplementary Information The online version contains supplementary material available at 10.1007/s00198-023-06926-0.

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Section: Discussionmentioning

confidence: 99%

Prevalence of denosumab-induced hypocalcemia: a retrospective observational study of patients routinely monitored with ionized calcium post-injection

Spångeus,

Rydetun,

Woisetschläger

2023

Osteoporos Int

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“…Magnesium can activate the calcium‐sensing receptor and decrease PTH synthesis and secretion. ( 20 ) Hypomagnesemia also results in a resistance to PTH because intracellular magnesium is a cofactor for adenylate cyclase. ( 20 ) Abnormalities in serum magnesium require further evaluation to determine the cause, and correction is necessary in order to improve calcium homeostasis, especially in patients on PTH therapy.…”

Section: Etiologymentioning

confidence: 99%

“…(19) Permanent HypoPT should be differentiated from transient nonsurgical HypoPT, which can be caused by hypo-or hypermagnesemia. (20)(21)(22) Maternal hypercalcemia can result in infantile hypocalcemia and infants of mothers with familial hypocalciuric hypercalcemia can also have HypoPT. (14,23,24) Pseudo-HypoPT or vitamin D disorders can also present with hypocalcemia; however, PTH is elevated.…”

Section: Nonsurgical Hypoptmentioning

confidence: 99%

Evaluation and Management of Hypoparathyroidism Summary Statement and Guidelines from the Second International Workshop

Khan

Bilezikian

Brandi³

et al. 2020

Journal of Bone and Mineral Research

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This clinical practice guideline addresses the prevention, diagnosis, and management of hypoparathyroidism (HypoPT) and provides evidence‐based recommendations. The HypoPT task forces included four teams with a total of 50 international experts including representatives from the sponsoring societies. A methodologist (GG) and his team supported the taskforces and conducted the systematic reviews. A formal process following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology and the systematic reviews provided the structure for seven of the guideline recommendations. The task force used a less structured approach based on narrative reviews for 20 non‐GRADEd recommendations. Clinicians may consider postsurgical HypoPT permanent if it persists for >12 months after surgery. To predict which patients will not develop permanent postsurgical HypoPT, we recommend evaluating serum PTH within 12 to 24 hours post total thyroidectomy (strong recommendation, moderate quality evidence). PTH > 10 pg/mL (1.05 pmol/L) virtually excludes long‐term HypoPT. In individuals with nonsurgical HypoPT, genetic testing may be helpful in the presence of a positive family history of nonsurgical HypoPT, in the presence of syndromic features, or in individuals younger than 40 years. HypoPT can be associated with complications, including nephrocalcinosis, nephrolithiasis, renal insufficiency, cataracts, seizures, cardiac arrhythmias, ischemic heart disease, depression, and an increased risk of infection. Minimizing complications of HypoPT requires careful evaluation and close monitoring of laboratory indices. In patients with chronic HypoPT, the panel suggests conventional therapy with calcium and active vitamin D metabolites as first‐line therapy (weak recommendation, low‐quality evidence). When conventional therapy is deemed unsatisfactory, the panel considers the use of PTH. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

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“…Hypomagnesemia is associated with impaired release of PTH from the parathyroid cell, likely through a disturbance in the stimulus‐secretion coupling mechanism. ( 105 ) Because both Mg and Ca activate the CaSR and reduce PTH synthesis and secretion, ( 106 ) albeit with different potencies, elevated levels of extracellular Mg can lead to functional hypoparathyroidism. Hypomagnesemia can also cause PTH resistance and functional hypoparathyroidism.…”

Section: Etiology Of Hypoparathyroidismmentioning

confidence: 99%

“…Hypomagnesemia can also cause PTH resistance and functional hypoparathyroidism. (105,(107)(108)(109)…”

Section: Metabolic Disordersmentioning

confidence: 99%

Etiology and Pathophysiology of Hypoparathyroidism: A Narrative Review

Pasieka

Wentworth

Yeo

et al. 2020

Journal of Bone and Mineral Research

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The approach utilized a systematic review of the medical literature executed with specifically designed criteria that focused on the etiologies and pathogenesis of hypoparathyroidism. Enhanced attention by endocrine surgeons to new knowledge about parathyroid gland viability are reviewed along with the role of intraoperative parathyroid hormone (ioPTH) monitoring during and after neck surgery. Nonsurgical etiologies account for a significant proportion of cases of hypoparathyroidism (~25%), and among them, genetic etiologies are key. Given the pervasive nature of PTH deficiency across multiple organ systems, a detailed review of the skeletal, renal, neuromuscular, and ocular complications is provided. The burden of illness on affected patients and their caregivers contributes to reduced quality of life and social costs for this chronic endocrinopathy. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

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Magnesium Homeostasis

Cited by 3 publications

References 46 publications

Prevalence of denosumab-induced hypocalcemia: a retrospective observational study of patients routinely monitored with ionized calcium post-injection

Prevalence of denosumab-induced hypocalcemia: a retrospective observational study of patients routinely monitored with ionized calcium post-injection

Evaluation and Management of Hypoparathyroidism Summary Statement and Guidelines from the Second International Workshop

Etiology and Pathophysiology of Hypoparathyroidism: A Narrative Review

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