ASBMR

Hypercalcemia of malignancy: How do treatment options stack up?

September 19, 2025

In this large, real-world cohort, denosumab and bisphosphonates showed comparable effectiveness in normalizing serum calcium levels among hospitalized patients with hypercalcemia of malignancy (HCM). These findings, presented at the American Society for Bone and Mineral Research (ASBMR) Annual Meeting, suggest that either agent may be appropriate for inpatient management, allowing flexibility in treatment decisions based on patient-specific factors and institutional protocols. While prospective trials are needed to confirm long-term outcomes and assess cost-effectiveness, current evidence supports the use of both therapies in clinical practice.

This retrospective cohort study analyzed 822 inpatient admissions for HCM from 2016 to 2025, comparing denosumab with bisphosphonates (pamidronate or zoledronic acid) using EHR data. Adults with serum calcium >10.5 mg/dL who received one of the agents during admission were included. Primary outcome was time to calcium normalization (≤10.5 mg/dL), adjusted for confounding via propensity-score overlap weighting.

Pamidronate was the most used agent (74%), followed by zoledronic acid (21%) and denosumab (5%). Median time to calcium normalization was 2.3 days for denosumab and 2.2 days for bisphosphonates (hazard ratio, 0.83; 95% confidence interval, 0.57–1.21), indicating no significant difference in effectiveness. Use of denosumab and zoledronic acid increased over time, while pamidronate use declined.

Source:

Milosavljevic, J. et al. American Society for Bone and Mineral Research (ASBMR) Annual Meeting. Denosumab versus Bisphosphonates for Inpatient Hypercalcemia of Malignancy: A Real-World Comparative Analysis. Oral presentation 1108. https://asbmr.confex.com/asbmr/2025/meetingapp.cgi/Paper/5099