Denosumab-Induced Proximal Myopathy in a Child

Abstract

Denosumab, a fully humanized monoclonal antibody, has been used for the treatment of osteoporosis, in complications resulting from bone metastatic disease and in giant cell tumor in both adults and skeletally mature adolescents. Denosumab is an inhibitor of the receptor activator of nuclear factor kappa-B ligand and belongs to a new class of antiresorptive medications. We report a unique case of myopathy in a 13-year-old boy prescribed denosumab for enchondromatosis. The boy presented with hypovitaminosis D, elevated parathyroid hormone, suppressed alkaline phosphatase, hypocalcemia, and hypophosphatemia after a single dose of denosumab. Our case points to altered calcium–vitamin D homeostasis induced by denosumab. Myopathy associated with denosumab has not been described previously in children. Early recognition of myopathy and adequate supplementation with calcium–vitamin D may ensure a more favorable clinical outcome.

Keywords

denosumab - myopathy - hypovitaminosis D - calcium - weakness

Publikationsverlauf

Eingereicht: 19. Januar 2021

Angenommen: 18. März 2021

Artikel online veröffentlicht:
11. Juni 2021

• References

• 1 Boyce AM. Denosumab: an emerging therapy in pediatric bone disorders. Curr Osteoporos Rep 2017; 15 (04) 283-292
• 2 Ishikawa K, Nagai T, Sakamoto K. et al. High bone turnover elevates the risk of denosumab-induced hypocalcemia in women with postmenopausal osteoporosis. Ther Clin Risk Manag 2016; 12: 1831-1840
• 3 Bone HG, Bolognese MA, Yuen CK. et al. Effects of denosumab treatment and discontinuation on bone mineral density and bone turnover markers in postmenopausal women with low bone mass. J Clin Endocrinol Metab 2011; 96 (04) 972-980
• 4 Gossai N, Hilgers MV, Polgreen LE, Greengard EG. Critical hypercalcemia following discontinuation of denosumab therapy for metastatic giant cell tumor of bone. Pediatr Blood Cancer 2015; 62 (06) 1078-1080
• 5 Boyce AM, Chong WH, Yao J. et al. Denosumab treatment for fibrous dysplasia. J Bone Miner Res 2012; 27 (07) 1462-1470
• 6 Rasheed K, Sethi P, Bixby E. Severe vitamin d deficiency induced myopathy associated with rhabydomyolysis. N Am J Med Sci 2013; 5 (05) 334-336
• 7 Sharma V, Borah P, Basumatary LJ, Das M, Goswami M, Kayal AK. Myopathies of endocrine disorders: a prospective clinical and biochemical study. Ann Indian Acad Neurol 2014; 17 (03) 298-302
• 8 Lipton A, Fizazi K, Stopeck AT. et al. Superiority of denosumab to zoledronic acid for prevention of skeletal-related events: a combined analysis of 3 pivotal, randomised, phase 3 trials. Eur J Cancer 2012; 48 (16) 3082-3092
• 9 Grasemann C, Schündeln MM, Hövel M. et al. Effects of RANK-ligand antibody (denosumab) treatment on bone turnover markers in a girl with juvenile Paget's disease. J Clin Endocrinol Metab 2013; 98 (08) 3121-3126
• 10 Karras NA, Polgreen LE, Ogilvie C, Manivel JC, Skubitz KM, Lipsitz E. Denosumab treatment of metastatic giant-cell tumor of bone in a 10-year-old girl. J Clin Oncol 2013; 31 (12) e200-e202