3.2 Bone Metastases and Hypercalcemia of Malignancy

Supportive Care lecture

which form of bone cell builds bones?

osteo-BLASTs

which type of bone cell breaks down the bone?

osteo-CLASTs

describe osteoblastic bone metastases

osteoCLASTs and osteoBLASTs are stimulated

the osteoblasts deposit bone in sites unrelated to where osteoclasts are active

describe osteolytic bone metastases

only osteoclasts are stimulated

not directly tumor mediated

why is bone metastases an issue fam?

painful

can cause hypercalcemia

increases risk of fracture

treatment for bone metastases (3 options)

1. treat the underlying cancer

2. bisphosphonates (IV)

3. denosumab (RANKL inhibitor)

IV bisphosphonates reduce the incidence of…

skeletal related events (SRE)

IV bisphosphonates improve both _____ and _______

pain

quality of life

what are the two IV bisphosphonates given for bone metastases?

zoledronic acid and pamidronate

dosing of zoledronic acid

(dose, route, frequency)

4 mg IV every 4 or 12 weeks

dosing of pamidronate

(dose, route, freqency)

90 mg IV every 3-4 weeks

zoledronic acid can cause toxicity of ______ so it requires adjustments for any issues with that organ

kidney

zoledronic acid dosing must be adjusted if the pt has…

renal issues

all IV bisphosphonates and denosumab can cause ______ and therefore ALL patients on them need to have a dental screening

osteonecrosis of the jaw

all IV bisphosphonates and denosumab can cause osteonecrosis of the jaw and therefore ALL patients on them need to have…

a dental screening

who is Contraindicated from taking IV bisphosphonates and denosumab?

osteonecrosis of the jaw

pts on IV bisphosphonates and denosumab require supplementation of ____

calcium and vitamin D

which has a higher incidence of hypocalcemia, zoledronic acid or denosumab?

denosumab

mild hypercalcemia of malignancy corrected calcium range

10.5 - 11.9

moderate hypercalcemia of malignancy corrected calcium range

12-14

severe hypercalcemia of malignancy corrected calcium range

>14

corrected Ca of 10.5-11.9 can be treated…

outpatient

corrected Ca of 12-14 might need to be treated…

inpatient

corrected Ca levels of >14 NEED to be treated

inpatient

what is the formula for corrected calcium?

Ca = [measured total ca + 0.02 x (40 - albumin)]

hypercalcemia treatment, all patients will get…

FLUIDS

moderate hypercalcemia treatment

fluids

IV bisphosphonate x 1

(ZA is preference)

T or F:

moderate hypercalcemia pts receiving IV bisphosphonates require renal adjustments and must be dentally cleared

F

(bc it is a one time does they are fine)

severe / life threatening hypercalcemia treatment

fluids

IV bisphosphonates x 1 dose

calcitonin

refractory hypercalcemia treatment

SC denosumab

steroids

dialysis