Influence of bone metastases on presentation and management of malignant hypercalcemia: a single-center cohort

Ergin Aydemir; Ayşe Ocak Duran; Berkan Karabuğa; Mehmet Emin Yılmaz; Osman Bilge Kaya; Sedef Tatar Bolat; Fatih Tay; Mustafa Büyükkör

Influence of bone metastases on presentation and management of malignant hypercalcemia: a single-center cohort

Abstract

Aims: Malignancy-associated hypercalcemia (MAH) is a severe metabolic complication affecting 2-3% of cancer patients, with higher prevalence in multiple myeloma (20-30%), lung cancer (12-15%), and breast cancer (10-20%). Median survival following MAH diagnosis ranges from 25 to 68 days, highlighting its status as an oncological emergency. This retrospective study examines demographic characteristics, clinical findings, treatment responses, and survival outcomes in patients with malignant hypercalcemia, with particular emphasis on the influence of bone metastasis on the presentation, severity, and management of hypercalcemia. Methods: This retrospective cohort study included 124 cancer patients aged 18 years or older who were hospitalized for malignant hypercalcemia at a tertiary oncology training and research hospital between January 2018 and December 2023. Inclusion criteria were a corrected serum calcium level of at least 10.5 mg/dl and a diagnosis of active malignancy. Collected data encompassed demographic characteristics, primary cancer diagnosis, disease stage, presence of bone metastases, laboratory values, treatment modalities, treatment responses, and survival times. Statistical analyses were performed using SPSS 26.0. Survival was assessed using the Kaplan-Meier method, and inter-group comparisons were performed using the log-rank test. A p-value below 0.05 was considered statistically significant. Results: The median age of the cohort was 58 years (range: 21-90 years), with an equal gender distribution (50.0% female, 50.0% male). The median corrected calcium level at diagnosis was 12.77 mg/dl (range: 10.5-21.0 mg/dl). Bone metastases were identified in 66.9% of patients at the time of malignant hypercalcemia diagnosis, with primary tumor distribution as follows: breast cancer 33.9%, lung cancer 20.1%, and other cancers 46.0%. Treatment modalities comprised bisphosphonates (66.9%), hydration alone (23.4%), and denosumab (9.7%). The median time to normalization of hypercalcemia was 4.0 days (range: 1-16), varying by treatment: hydration-diuretic 3.0 days, bisphosphonates 4.0 days, and denosumab 3.0 days (p=0.032). After hypercalcemia diagnosis, the median survival was 2.0 months (range: 0-60), with a 75% mortality rate within 6 months. Prior bisphosphonate use correlated with improved survival in breast cancer patients (57.0 vs 22.0 months, p=0.002), but not in lung cancer patients (8.0 vs 8.0 months, p>0.05). At the end of follow-up, 91.9% of patients had died. Conclusion: Malignant hypercalcemia mostly affects patients with advanced cancer and a high rate of bone metastasis (66.9%). However, having bone involvement did not independently affect survival or the time it took for calcium levels to return to normal. The only factor that predicted poor survival after hypercalcemia was Eastern Cooperative Oncology Group (ECOG) performance status, which suggests that systemic factors are more important than the extent of bone disease in determining outcomes. The longer survival seen in breast cancer patients who had used bisphosphonates before should be viewed with caution, as this may be due to immortal time bias and confounding by indication. Overall, these results highlight the poor outlook for malignant hypercalcemia and stress the need for early detection and proper treatment.

Keywords

Supporting Institution

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Project Number

2026-03/43

Ethical Statement

The study was initiated with the approval of the Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital Clinical Researches Ethics Committee (Date: 05.03.2026, Decision No: 2026-03/43). Because the study was designed retrospectively, no written informed consent form was obtained from patients.

Thanks

We thank all patients who participated in this study and the medical staff at Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital for their support in data collection.

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Details

Primary Language

English

Subjects

Clinical Oncology, Oncology and Carcinogenesis (Other)

Journal Section

Research Article

Authors

Ergin Aydemir ^*
0000-0003-0498-6308
Türkiye

Ayşe Ocak Duran
0000-0002-1703-726X
Türkiye

Berkan Karabuğa
0000-0001-5357-7610
Türkiye

Mehmet Emin Yılmaz
0000-0002-2361-6591
Türkiye

Osman Bilge Kaya
0000-0002-9795-8631
Türkiye

Sedef Tatar Bolat
0009-0005-9883-9211
Türkiye

Fatih Tay
0000-0002-4672-4173
Türkiye

Mustafa Büyükkör
0000-0002-3458-525X
Türkiye

Publication Date

July 16, 2026

Submission Date

March 23, 2026

Acceptance Date

May 25, 2026

Published in Issue

Year 2026 Volume: 8 Number: 4

IZ

https://izlik.org/JA39LR96WL

Cite

RIS / Bibtex

APA

Aydemir, E., Ocak Duran, A., Karabuğa, B., Yılmaz, M. E., Kaya, O. B., Tatar Bolat, S., Tay, F., & Büyükkör, M. (2026). Influence of bone metastases on presentation and management of malignant hypercalcemia: a single-center cohort. Anatolian Current Medical Journal, 8(4), 638-644. https://izlik.org/JA39LR96WL

AMA

1.Aydemir E, Ocak Duran A, Karabuğa B, et al. Influence of bone metastases on presentation and management of malignant hypercalcemia: a single-center cohort. Anatolian Curr Med J / ACMJ / acmj. 2026;8(4):638-644. https://izlik.org/JA39LR96WL

Chicago

Aydemir, Ergin, Ayşe Ocak Duran, Berkan Karabuğa, et al. 2026. “Influence of Bone Metastases on Presentation and Management of Malignant Hypercalcemia: A Single-Center Cohort”. Anatolian Current Medical Journal 8 (4): 638-44. https://izlik.org/JA39LR96WL.

EndNote

Aydemir E, Ocak Duran A, Karabuğa B, Yılmaz ME, Kaya OB, Tatar Bolat S, Tay F, Büyükkör M (July 1, 2026) Influence of bone metastases on presentation and management of malignant hypercalcemia: a single-center cohort. Anatolian Current Medical Journal 8 4 638–644.

IEEE

[1]E. Aydemir et al., “Influence of bone metastases on presentation and management of malignant hypercalcemia: a single-center cohort”, Anatolian Curr Med J / ACMJ / acmj, vol. 8, no. 4, pp. 638–644, July 2026, [Online]. Available: https://izlik.org/JA39LR96WL

ISNAD

Aydemir, Ergin - Ocak Duran, Ayşe - Karabuğa, Berkan - Yılmaz, Mehmet Emin - Kaya, Osman Bilge - Tatar Bolat, Sedef - Tay, Fatih - Büyükkör, Mustafa. “Influence of Bone Metastases on Presentation and Management of Malignant Hypercalcemia: A Single-Center Cohort”. Anatolian Current Medical Journal 8/4 (July 1, 2026): 638-644. https://izlik.org/JA39LR96WL.

JAMA

1.Aydemir E, Ocak Duran A, Karabuğa B, Yılmaz ME, Kaya OB, Tatar Bolat S, Tay F, Büyükkör M. Influence of bone metastases on presentation and management of malignant hypercalcemia: a single-center cohort. Anatolian Curr Med J / ACMJ / acmj. 2026;8:638–644.

MLA

Aydemir, Ergin, et al. “Influence of Bone Metastases on Presentation and Management of Malignant Hypercalcemia: A Single-Center Cohort”. Anatolian Current Medical Journal, vol. 8, no. 4, July 2026, pp. 638-44, https://izlik.org/JA39LR96WL.

Vancouver

1.Ergin Aydemir, Ayşe Ocak Duran, Berkan Karabuğa, Mehmet Emin Yılmaz, Osman Bilge Kaya, Sedef Tatar Bolat, Fatih Tay, Mustafa Büyükkör. Influence of bone metastases on presentation and management of malignant hypercalcemia: a single-center cohort. Anatolian Curr Med J / ACMJ / acmj [Internet]. 2026 Jul. 1;8(4):638-44. Available from: https://izlik.org/JA39LR96WL