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In Reply:

University of California San Francisco, San Francisco, CA.

In response to the points raised, there was no provision for patients to receive calcium and vitamin D during this trial.¹ Although serum calcium was not measured at 3 to 7 days after the administration of pamidronate, it was measured at week 3 and every 3 weeks thereafter. There were no clinical manifestations of hypocalcemia, and in fact, no differences in the frequency of hypocalcemia between the pamidronate and placebo cohorts (< 1%) were observed. Undoubtedly more episodes of asymptomatic hypocalcemia would have been observed had laboratory measurements been obtained more frequently.

Although the frequency of hypocalcemia is low, the frequency of subclinical vitamin D deficiency² and the potential for severe hypocalcemia in patients with occult vitamin D deficiency³ warrant supplementation with both vitamin D and calcium for men receiving bisphosphonates for metastatic prostate cancer.

Author's Disclosures of Potential Conflicts of Interest

The author indicated no potential conflicts of interest.

REFERENCES

1. Small EJ, Smith MR, Seaman JJ, et al: Combined analysis of two multicenter, randomized, placebo-controlled studies of pamidronate disodium for the palliation of bone pain in men with metastatic prostate cancer. J Clin Oncol 21:4270-4276, 2003[Abstract/Free Full Text]

2. Smith MR, McGovern FJ, Zietman AL, et al: Pamidronate to prevent bone loss during androgen deprivation therapy for prostate cancer. N Engl J Med 345:948-955, 2001[Abstract/Free Full Text]

3. Rosen CJ, Brown S: Severe hypocalcemia after intravenous bisphosphonate therapy in occult vitamin D deficiency. N Engl J Med 348:1503-1504, 2003[Free Full Text]

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