Denosumab for the treatment of bisphosphonate resistant hypercalcemia in a hemodialysis patient

The acronym of malignancy, iatrogenic, intoxication and immobilization, sarcoidosis, hyperparathyroidism and hyperthyroidism, milk-alkali syndrome, and paget is very helpful in diagnosing hypercalcemia. We report on a 94-year-old patient with history of end-stage renal failure secondary to benign nephroangiosclerosis, who was on maintenance hemodialysis during dialysis, his blood chemistry revealed mild hypercalcemia (2.66 mmol/L) with normal level of intact primary hyperparathyroidism (32.37 ng/mL) mandating the discontinuation of Vitamin D[3]. In view of persisting hypercalcemia, denosumab 60 mg/mL was administrated subcutaneously. The serum calcium level showed a decrease and stabilized at near upper limit (2.57 mmol/L). Three weeks later, the serum calcium remained mildly elevated fluctuating between 2.66 and 2.80 mmol/L.