The Journal of Clinical Endocrinology & Metabolism· 2026Q1
Comparative effectiveness of denosumab versus bisphosphonates for hypercalcemia of malignancy: a real-world cohort study
- 1citations
- Q1SCImago
- 2026year
Short summary
In a real-world study of 836 patients with hypercalcemia of malignancy, denosumab and bisphosphonates demonstrated similar rates of calcium normalization (median 1.58 vs 1.62 days), hypocalcemia, and hypercalcemia recurrence, but denosumab was associated with lower 90-day mortality (HR 0.51).
AI-generated from the title and abstract; the full text is not read.
Key points
- Denosumab and bisphosphonates showed similar median times to calcium normalization (1.58 vs 1.62 days) in hypercalcemia of malignancy.
- Rates of hypocalcemia and 90-day hypercalcemia recurrence were comparable between denosumab and bisphosphonate groups.
- 90-day all-cause mortality was significantly lower in patients treated with denosumab (HR 0.51) compared to bisphosphonates.
- The study included 836 patients, with 6.3% receiving denosumab and 93.7% receiving bisphosphonates.
AI-generated from the title and abstract; the full text is not read.
Abstract
CONTEXT: The 2023 Endocrine Society guideline conditionally favors denosumab over intravenous bisphosphonates for hypercalcemia of malignancy (HCM), but direct comparative evidence is scarce. OBJECTIVE: To compare effectiveness of denosumab versus bisphosphonates for the treatment of HCM. DESIGN AND SETTING: Observational cohort study of adults hospitalized with HCM between January 2016 and January 2026 at a large academic safety-net hospital system in the Bronx, NY. PATIENTS: Adults aged ≥18 years with serum calcium >10.5 mg/dL, active or prior malignancy, and treated with bisphosphonates or denosumab as inpatient. Patients with eGFR <15 mL/min/1.73 m2 or recent antiresorptive exposure were excluded. INTERVENTIONS: Intravenous bisphosphonate (zoledronic acid or pamidronate) versus denosumab. MAIN OUTCOME MEASURES: Primary outcome was time to serum calcium normalization (≤10.5 mg/dL). Secondary outcomes included hypocalcemia, hypercalcemia recurrence, and 90-day all-cause mortality. Propensity score overlap weighting balanced baseline covariates. RESULTS: Among 836 patients (mean age 67.0 years; 50.1% female; 44.9% non-Hispanic Black, 29.9% Hispanic) contributing 869 admissions, 814 (93.7%) received bisphosphonates and 55 (6.3%) denosumab. Time to normalization was similar (median 1.62 vs 1.58 days; HR 0.80; 95% CI, 0.57-1.12). Hypocalcemia (HR 0.86; 95% CI, 0.58-1.26) and 90-day recurrence (HR 0.97; 95% CI, 0.54-1.74) did not differ. Ninety-day mortality was lower with denosumab (HR 0.51; 95% CI, 0.30-0.88). CONCLUSIONS: Denosumab and bisphosphonates were associated with similar calcium normalization, hypocalcemia, and recurrence rates in this real-world observational cohort. The lower 90-day mortality observed with denosumab warrants prospective investigation given the limitations of observational research.
The authors' abstract, as published at the source. The Journal of Clinical Endocrinology & Metabolism, 2026 · DOI ↗
Continue with a free account
Ask the paper: 3 free questions a day about this paper; save it, get its citation, new summaries every day for your field. Takeaways are Premium.
Continue free on the webSign in with Google or Apple; no card needed. You come back to this paper.
On your phone:
Field: Oncology
OncologyMedicine