Severe Symptomatic Hypocalcaemia Following High-Dose Oral Ibandronate in a Patient With Prior Thyroidectomy and Metastatic Bone Disease
Bibliographic record
Abstract
Ibandronate is used to treat bony metastatic disease and hypercalcaemia of malignancy. We report the first case of severe hypocalcaemia following oral ibandronate. A 65-year-old woman with widespread sclerotic bony metastases due to breast cancer was commenced on oral ibandronate (50 mg daily). The corrected calcium level decreased from 2.11 mmol / L to 1.38 mmol / L (2.1 - 2.6 mmol / L) accompanied by lower leg muscle cramps 3 weeks after initiation of ibandronate therapy. She had an inappropriately normal PTH level of 6.8 pmol / L (1 - 7 pmol/L) with normal 25-OH vitamin D level of 59 nmol / L and normal magnesium level of 0.88 mmol / L (0.7 - 1.05 mmol / L). There was a history of previous total thyroidectomy for multinodular goitre. Intermittent calcium infusion was required to maintain the corrected calcium level around 1.9 - 2 mmol / L over the next 3 weeks. The patient was discharged on calcium citrate 250 mg tds and calcitriol 0.5 mcg qid with calcium level of 1.96 mmol / L. We conclude that oral bisphosphonates are widely used but rarely associated with symptomatic severe hypocalcaemia. Possible mechanisms in this case include hypoparathyroidism and metastatic bone disease with widespread sclerosis. This case demonstrates that patients may develop symptomatic hypocalcaemia when treated with oral bisphosphonates. doi:10.4021/jem96w
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".