停經後骨質疏鬆症婦女使用Denosumab引起嚴重低血鈣之案例報告

Denosumab 是一種人類單株抗體，對於細胞核因子kappa-B 配體接受體活化因子 (receptor activator of nuclear factor kappa-B ligand) 具有親和力及專一性，可降低停經後骨質疏鬆症婦女之脊椎、非脊椎和髖骨骨折的發生率，腎功能不全之患者不須調整使用劑量。denosumab 最常見的不良反應包括有背痛、四肢疼痛、以及肌肉骨骼疼痛等；嚴重症狀性低血鈣症為罕見、嚴重且可能威脅生命的副作用。本文探討一位94 歲女性，有慢性腎臟病病史，診斷有骨質疏鬆症合併左側股骨頸骨折，初次施打denosumab 60 mg，23 天後出現嚴重低血鈣，心電圖檢查有QT 間隔延長，住院期間給予靜脈輸注氯化鈣，5 天後其校正血鈣值回復至正常範圍。根據研究，嚴重腎功能不全的病人使用denosumab 會增加低血鈣的風險，建議每天補充鈣質與維生素D 以維持血鈣濃度，於施打後兩週內追蹤血鈣數值。提醒臨床醫療人員應注意此嚴重藥物不良反應，並衛教患者如果出現低血鈣的徵兆或症狀，需立即就醫診治。

關鍵字

Denosumab ；骨質疏鬆症；低血鈣；慢性腎臟病

並列摘要

Denosumab is a human monoclonal antibody with affinity and specificity for receptor activator of nuclear factor kappa-B ligand (RANKL). In postmenopausal women with osteoporosis, denosumab reduces the risk of vertebral, nonvertebral, and hip fractures. No dose adjustment is necessary in patients with renal impairment. The most common adverse reactions reported with denosumab are back pain, pain in extremity, and musculoskeletal pain. Severe symptomatic hypocalcemia is a rare but potentially life-threatening adverse event. We report the case of a 94-year-old woman with chronic kidney disease who received a single dose of denosumab for treatment of osteoporosis. Twenty-three days later, she developed severe hypocalcemia associated with prolonged QT interval. She was treated with intravenous calcium chloride, and her serum calcium level returned to normal range after five days of hospitalization. Hypocalcemia following injection of denosumab is a significant risk in patients with severe renal impairment. Calcium and vitamin D supplementation is an important component of prevention of hypocalcemia. Monitoring of calcium level is highly recommended within 14 days of denosumab injection. Clinicians should be aware of the possibility of severe hypocalcemia after denosumab administration, and patients must notice the symptoms of hypocalcemia.

並列關鍵字

Denosumab ； Osteoporosis ； Hypocalcemia ； Chronic Kidney Disease

國際替代計量

停經後骨質疏鬆症婦女使用Denosumab引起嚴重低血鈣之案例報告

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