A 55-year-old woman with breast cancer develops acute confusion, lethargy, and a calcium of 3.6 mmol/L. She is severely dehydrated with a creatinine

Question

A 55-year-old woman with breast cancer develops acute confusion, lethargy, and a calcium of 3.6 mmol/L. She is severely dehydrated with a creatinine of 200 µmol/L. After adequate IV fluid resuscitation and calcitonin, what bisphosphonate is most appropriate and why?

Accepted Answer

Denosumab – as bisphosphonates are contraindicated with creatinine >200

Answer

Ibandronate – as it has the best renal safety profile

Answer

Zoledronic acid – as it is more effective regardless of renal function

Answer

Pamidronate – as zoledronic acid is contraindicated in renal impairment

Answer

Either – as both have equal efficacy and renal safety

Hypercalcaemia with Renal Impairment — RACP Adult Medicine MCQ

A 55-year-old woman with breast cancer develops acute confusion, lethargy, and a calcium of 3.6 mmol/L. She is severely dehydrated with a creatinine of 200 µmol/L. After adequate IV fluid resuscitation and calcitonin, what bisphosphonate is most appropriate and why?