Kuan Sturgill1, Justin P Reinert1,2. 1. Bon Secours Mercy Health St. Vincent Medical Center, Toledo, OH, USA. 2. The Ben and Maytee Fisch College of Pharmacy, The University of Texas at Tyler, Tyler, TX, USA.
Abstract
Objective: The purpose of this review is to discuss the existing literature regarding patients who have experienced seizures after administration of a bone density conservation agent (BDCA). Data Sources: A comprehensive literature review was performed between September and October 2021 using the following keywords: osteoporosis/drug therapy, seizures/chemically induced, hypercalcemia, hypocalcemia, osteoporosis, seizure risk, osteoclast medication, seizures, bisphosphonates, risedronate, zoledronic acid, pamidronate, denosumab, Prolia, Xgeva, calcitonin, BDCAs. Study Selection and Data Extraction: A total of 90 articles were identified, but only 6 articles met prespecified inclusion and exclusion criteria. These articles included 4 case reports, 1 case series, and 1 retrospective cohort study. Data Synthesis: Two case reports and 1 case series described the occurrence of seizures with the use of zoledronic acid. One case report described the occurrence of seizures with the use of alendronate, 1 retrospective cohort study with the use of denosumab, and 1 case report with the use of calcitonin. The articles displayed a variety of contributing factors that could have caused seizures including those with a prior history of seizures, calcium or vitamin D deficiency prior to starting therapy, a history of gastrectomy impairing glucose homeostasis, or concurrent infection. Conclusion: While there is not a direct link to BDCA causing seizures, the hypocalcemic effect may be severe enough in some patients to precipitate a seizure. The correction of underlying conditions and electrolyte disturbances should be addressed before initiating a BDCA. Further studies are needed to better explore the relationship between BDCA and seizures.
Objective: The purpose of this review is to discuss the existing literature regarding patients who have experienced seizures after administration of a bone density conservation agent (BDCA). Data Sources: A comprehensive literature review was performed between September and October 2021 using the following keywords: osteoporosis/drug therapy, seizures/chemically induced, hypercalcemia, hypocalcemia, osteoporosis, seizure risk, osteoclast medication, seizures, bisphosphonates, risedronate, zoledronic acid, pamidronate, denosumab, Prolia, Xgeva, calcitonin, BDCAs. Study Selection and Data Extraction: A total of 90 articles were identified, but only 6 articles met prespecified inclusion and exclusion criteria. These articles included 4 case reports, 1 case series, and 1 retrospective cohort study. Data Synthesis: Two case reports and 1 case series described the occurrence of seizures with the use of zoledronic acid. One case report described the occurrence of seizures with the use of alendronate, 1 retrospective cohort study with the use of denosumab, and 1 case report with the use of calcitonin. The articles displayed a variety of contributing factors that could have caused seizures including those with a prior history of seizures, calcium or vitamin D deficiency prior to starting therapy, a history of gastrectomy impairing glucose homeostasis, or concurrent infection. Conclusion: While there is not a direct link to BDCA causing seizures, the hypocalcemic effect may be severe enough in some patients to precipitate a seizure. The correction of underlying conditions and electrolyte disturbances should be addressed before initiating a BDCA. Further studies are needed to better explore the relationship between BDCA and seizures.
Authors: Mimi I Hu; Ilya G Glezerman; Sophie Leboulleux; Karl Insogna; Rasim Gucalp; Waldemar Misiorowski; Bennett Yu; Paul Zorsky; Diego Tosi; Alberto Bessudo; Arnaud Jaccard; Giuseppe Tonini; Wendy Ying; Ada Braun; Rajul K Jain Journal: J Clin Endocrinol Metab Date: 2014-06-10 Impact factor: 5.958