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TOPLINE:
A real-world cohort study showed no difference in efficacy between denosumab and bisphosphonates in treating inpatients with hypercalcemia of malignancy.
METHODOLOGY:
- A retrospective study of electronic health record data from January 2016 to April 2025 involved adults admitted to three hospitals with blood calcium level exceeding 10.5 mg/dL who received either an intravenous bisphosphonate or denosumab.
- The primary outcome was the time to calcium normalization (≤ 10.5 mg/dL).
- Cox proportional hazards model and propensity-score overlap weighting were used.
TAKEAWAY:
- The study included 734 patients (50% women; mean age, 67 years; 45% non-Hispanic Black and 30% Hispanic) and 822 inpatient admissions.
- The most common malignancies were multiple myeloma (17%), lung carcinoma (15%), and lymphoma (15%).
- The agents used were pamidronate (74%), zoledronic acid (21%), and denosumab (5%).
- Median time to calcium normalization was 2.24 days for denosumab and 2.13 days for bisphosphonates (hazard ratio [HR], 0.81; 95% CI, 0.55-1.19).
- An exploratory analysis found that zoledronic acid was associated with a faster normalization time than denosumab (HR, 0.57; 95% CI, 0.35-0.89).
IN PRACTICE:
“Prospective randomized trials are warranted to confirm these findings.…Until such data are available, our results support the flexibility of selecting any of these agents based on individual patient characteristics and institutional protocols,” study author and presenter Jovan Milosavljevic, MD, of the Albert Einstein School of Medicine, New York City, said.
SOURCE:
The study was presented at the American Society for Bone and Mineral Research (ASBMR) 2025 Annual Meeting.
LIMITATIONS:
The study was retrospective and included a small number of patients treated with denosumab. The finding of superiority of denosumab over zoledronic acid was not a primary endpoint.
DISCLOSURES:
Milosavljevic had no conflicts of interest to disclose.
September 17, 2025 — Editor's note: This article has been updated to clarify that, in an exploratory analysis, zoledronic acid was associated with a faster normalization time, while denosumab had a slower normalization time.
