Cover Image




Immobilization hypercalcemia (IH) is a rare entity. It is seen in patients with long term immobilization, like spinal cord injury or long bone fracture, particularly in children and adolescents. Here we report a case of Immobilization              hypercalcemia in a patient with Brain injury, which was         clinically unnoticed and later presented with complications, which has significant impact on the cognition and affects  neurological recovery. The exact pathophysiology of            immobilisation related hypercalcemia is yet unknown, but rapid bone turnover is  supposed to be involved in the        process.We report a case of Immobilization hypercalcemia in a patient one year after traumatic brain injury. During the hospital stay, the patient had an episode of seizure. Routine blood investigations were normal except for high calcium levels. Further investigations revealed low parathyroid         hormone, normal 1,25-dihydroxy vitamin D and high 24-hour urinary calcium. He was diagnosed to have IH after ruling out all other causes of hypercalcemia. Treatment is targeted         to  wards lowering the serum calcium level by early                  mobilisation and exercises, intravenous hydration with          isotonic saline, frusemide, Calcitonin, Bisphosphonates which are conventional therapies. Newer treatment options include receptor activator of nuclear factor kappa-B ligand (RANKL) inhibitor, denosumab. Physicians dealing with long term bed ridden patients should keep this as a differential diagnosis which helps in avoiding unnecessary investigations chasing the aetiology, annoying recurrences and preventing life  threatening complications.


Full Text:



Approach to Hypercalcemia.pdf.

Albright F, Burnett CH, Cope O, Parsons W. Acute atrophy of bone (osteoporosis) simulating hyperparathyroidism. J Clin Endocrinol. 1941;1:711-716. - Google Search [Internet].

Maynard FM. Immobilization hypercalcemia following spinal cord injury. Arch Phys Med Rehabil. 1986 Jan 1;67(1):41–4.

BERGSTROM WH. HYpercalciuria and hypercalcemia complicating immobilization. Am J Dis Child. 1978 Jun 1;132(6):553–4.

Stewart AF, Adler M, Byers CM, Segre GV, Broadus AE. Calcium Homeostasis in Immobilization: An Example of Resorptive Hypercalciuria. N Engl J Med. 1982 May 13; 306(19):1136–40.

Naftchi NE, Viau AT, Sell GH, Lowman EW. Mineral metabolism in spinal cord injury. Arch Phys Med Rehabil. 1980 Mar;61(3): 139–42.

Sun X, Yang K, Wang C , Cao S, Merritt M, Hu Y, et al. Paradoxical response to mechanical unloading in bone loss, microarchitecture, and bone turnover markers. Int J Med Sci. 2015;12(3):270–9.

Brizendine K, Wells JM, Flanders SA, Saint S, Centor RM. Clinical problem-solving. In search of... N Engl J Med. 2010 Dec 2;363(23):2249–54.

Lietman SA, Germain-Lee EL, Levine MA. Hypercalcemia in Children and Adolescents. Curr Opin Pediatr. 2010 Aug;22(4): 508–15.

Naftchi NE, Viau AT, Sell GH, Lowman EW. Mineral metabolism in spinal cord injury. Arch Phys Med Rehabil. 1980 Mar;61(3): 139–42.

UCSF-BASIC-PDF-rutrqq.pdf [Internet]. [cited 2015 Apr 10]. Available from: 12. RLA stages .pdf.


Massagli TL, Cardenas DD. Immobilization hypercalcemia treatment with pamidronate disodium after spinal cord injury. Arch Phys Med Rehabil. 1999 Sep;80(9):998–1000.

Maier JD, Levine SN. Hypercalcemia in the Intensive Care Unit: A Review of Pathophysiology, Diagnosis, and Modern Therapy. J Intensive Care Med. 2015 Jul;30(5):235–52.

Gopal H, Sklar AH, Sherrard DJ. Symptomatic hypercalcemia of immobilization in a patient with end-stage renal disease. Am J Kidney Dis Off J Natl Kidney Found 2000 May;35(5):969–72.

Ahmad S, Kuraganti G, Steenkamp D. Hypercalcemic Crisis: A Clinical Review. Am J Med. 2015 Mar;128(3):239–45.

Drake MT, Clarke BL, Khosla S. Bisphosphonates: Mechanism of Action and Role in Clinical Practice. Mayo Clin Proc Mayo Clin. 2008 Sep;83(9):1032–45.

Major P, Lortholary A, Hon J, Abdi E, Mills G, Menssen HD, et al. Zoledronic acid is superior to pamidronate in the treatment of hypercalcemia of malignancy: a pooled analysis of two randomized, controlled clinical trials. J Clin Oncol Off J Am Soc Clin Oncol. 2001 Jan 15;19(2):558–67.

Hofbauer LC, Kühne CA, Viereck V. The OPG/RANKL/RANK system in metabolic bone diseases. J Musculoskelet Neuronal Interact. 2004 Sep;4(3):268–75.

Tsourdi E, Rachner TD, Rauner M, Hamann C, Hofbauer LC. Denosumab for bone diseases: translating bone biology into targeted therapy. Eur J Endocrinol. 2011 Dec 1;165(6):833–40.

Block GA, Bone HG, Fang L, Lee E, Padhi D. A single-dose study of denosumab in patients with various degrees of renal impairment. J Bone Miner Res Off J Am Soc Bone Miner Res. 2012 Jul;27(7):1471–9.


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.

An initiative of The Tamil Nadu Dr M.G.R. Medical University