Denosumab-associated hypocalcemia: Does gender play a role?

Abstract Objective It is well recognized that the presentation, treatment, and outcomes of various diseases may differ between men and women. We recently reported a 7.4% rate of denosumab-associated hypocalcemia in community-dwelling osteoporotic patients. This study sought to investigate the role of gender in this complication. Study design Retrospective community-dwelling cohort. Method The databases of a large health maintenance organization were searched for adult patients treated with denosumab for osteoporosis in 2010-2018. Rates and predictors of denosumab-associated hypocalcemia (serum calcium ≤8.5 mg/mL) were analyzed by gender. Results The cohort included 1871 women and 134 men. Compared with the women, the men were characterized by older median age (81 vs. 77 years,p = 0.005), higher likelihood to receive denosumab as a first-line treatment (22% vs. 6%, p  Conclusion Denosumab-treated men were significantly older than treated women and had a lower eGFR and more advanced osteoporosis. These findings suggest that selection bias rather than male genderper se underlies the higher rate of denosumab-associated hypocalcemia in men.