Dropping calcium levels bones mets

[G2779]

calcium levels

My dad just had lu177 treatment July 19 and also change to Decapeptyl 11.25 Aug 19 and in xgeva , Zytiga But his calcium is being drained by body every few days - doctors not sure why this happen , has anyone any ideas please help

[Tall_Allen]

Xgeva uses serum calcium to maintain bone mineral density. PSMA-617 (the ligand used with Lu-177), and other chelates (like the gadolinium contrast agent used with contrast MRIs), can chelate serum calcium. I assume they've checked his blood pH, parathyroid, Vitamin D, calcitonin, magnesium, phosphate, citrate, creatinine, and albumin, and they are normal, and that his blood volume is not abnormally high. Is he getting infusions to replace calcium?

[G2779 in reply to Tall_Allen]

My father Was took into hospital and given Iv yes , but are not willing to do this all time they said has to except its nearing the end giving him 4 calcium d3 forte tabs per day now , not sure what else we can do , he’s heart problems to

[Shanti1]

Drops in serum calcium while on bisphosphonates or Xgeva are an indication to take calcium and vitamin D to maintain calcium levels (I would also add in K2, magnesium and trace minerals, basically a good bone formula). When drops are severe, or not responsive to supplementation, calcium infusions may be indicated. Apart from serum calcium being an important electrolyte for nerve conductivity and muscle contraction, it has been postulated by Dr. Strum (Prostate Cancer: Essential Concepts for survival) and several scientific papers that low serum calcium when on bone building meds medications puts one at risk for osteonecrosis of the jaw.

[tango65]

Calcium metabolism is a complex subject. This is the way I understand why Xgeva (denosumab) may cause hypocalcemia (low blood calcium). Some people may disagree.

The bones are not static. Constant bone remodeling is essential for bone health. There is reabsorption of bone by the osteoclasts (freeing calcium) and at the same time there is building of bone by the osteoblast (incorporating calcium to the bones). This process is very complex and regulated by many factors and hormones.

Calcium blood levels (a very low % of all calcium in the body) are maintained in part by the parathyroid glands. When calcium in the blood goes down, the parathyroid hormone increases and stimulates the osteoclasts. There is increasing bone reabsorption with the freeing of calcium from the bone. The parathyroid hormone also increases the reabsorption of calcium in the urine. Normal calcium levels are maintained, mainly by using the calcium stored in the bones, increasing calcium absorption and reducing the urinary loss of calcium.

Denosumab (prolia, Xgeva) is a potent inhibitor of osteoclasts formation, activation and survival (decreasing bone reabsorption and the freeing of calcium from the bone). There is a positive increase of calcium in the bone, since there is incorporation of calcium by the osteoblast and the concomitant resorption of bone by the osteoclasts is decreased. This process could cause a drop of calcium in the blood. Parathyroid hormone levels could be elevated but they are not effective to maintain a normal calcemia, most probable because of the osteoclast inactivation.

Xgeva does not stimulates osteoblasts and production of new bone in consequence it does not increase the use of the calcium that there is in the blood . Its action is to decrease bone reabsorption meanwhile osteoblasts continue the normal building of bone.

Low blood levels of calcium happen in people taking denosumab. People taking Denosumab should monitors calcium and albumin levels and supplement with calcium and vitamin D if the calcium levels are low when corrected by the albumin levels.