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US thiazide-associated hypercalcemia rates peaked in 2006, then declined
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The incidence of thiazide-associated hypercalcemia began to increase in 1998, reached a peak in 2006 and decreased after that time, according to recent findings.
Robert A. Wermers, MD, of the Mayo Clinic, and colleagues evaluated 221 residents of Olmsted County, Minnesota, with thiazide-associated hypercalcemia who were identified through the Rochester Epidemiology Project and the Mayo Clinic Laboratory Information System. An updated cohort identified from 2002 to 2010 was combined with a historical cohort of previously identified cases from 1992 to 2001.
The patient population consisted of 191 women and 30 men, and the mean age at diagnosis was 67 years. Patients with thiazide-associated hypercalcemia were identified an average of 5.2 years after starting thiazide treatment.
The researchers found that the overall yearly age- and gender-adjusted incidence of thiazide-associated hypercalcemia was 12.2 per 100,000 person-years. Incidence began to increase after 1997, with an incidence of 19.3 per 100,000 person-year in 1998 and 19.7 per 100,000 person-years in 1999. Incidence peaked in 2006, with a rate of 20.4 per 100,000 person-years documented that year. The yearly rate decreased to 12.3 per 100,000 in 2010.
Women had a much higher age-adjusted rate (19.5 per 100,000 person-years) compared with men (3.6 per 100,000 person-years; P < .01) during the 1992 to 2010 study period. The highest incidence was recorded in women aged 65 to 74 years (76.3 per 100,000 person-years).
Sixty-two percent of the cohort did not have severe hypocalcemia despite continuing treatment with thiazide. Twenty-four percent of patients were diagnosed with primary hyperparathyroidism.
“We estimate that as many as 71% of subjects with thiazide-associated hypercalcemia may have underlying [primary hyperparathyroidism] based on the persistence of hypercalcemia in those who discontinue the medication,” the researchers wrote. “The most appropriate management strategy for these patients remains unclear. Discontinuation of thiazides may not be necessary in all patients given the mild and nonprogressive nature of the hypercalcemia that is observed and the potential benefits that are conferred to patients who continue treatment.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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