Associate Consultant, Department of General Medicine,Tan Tock Seng Hospital, Singapore
Rare Case Of Immobilization Induced Hypercalcemia
Dr Tan Yan Ru, Tan Tock Seng Hospital, Singapore
Dr Nihar Pandit, Tan Tock Seng Hospital, Singapore
Aims: Hypercalcemia secondary to Immobilization is an uncommon entity. The diagnosis is often made after an exhaustive evaluation to rule out other causes of hypercalcemia. It has been described especially in young adults with immobilization, such as those with spinal cord injuries.
This is a report of a gentleman who developed hypercalcemia after suffering an acute cord compression. This case contributes to the recognition of immobilization hypercalcemia.
Methods: A 60 year old male tennis coach presented with low back pain and lower limb weakness. He is subsequently diagnosed with polymicrobial bacteremia from lemierre’s syndrome following dental infection. It was complicated by L1-L3 spondylodiscitis and epidural abscess leading to cord compression and paraparesis. His adjusted calcium was normal on admission and it progressively increased during the hospitalization to a level of 3.12mmol/L. He was diagnosed as having immobilization hypercalcemia after all other causes of hypercalcemia were excluded.
Results: Immobilization hypercalcemia is an uncommon diagnosis which often affect young adults with limited mobility during the first six weeks after the precipitating injury  ; It can present even months after  as illustrated in our patient's case of relapsed hypercalcemia 4 months later. It is believed that muscle activity transmits a bone formation signal through the osteocyte. With immobilization, the mechanical stimulation for bone formation caused by muscle activity is reduced, leaving resorption unopposed.
The increased incidence in adolescents is related to the rapid bone turnover that accompanies growth, whereas that in males is possibly because of their greater bone mass compared to females. 
Conclusions: Patients with immobilization hypercalcemia responds well to intravenous bisphosphonates. Immobilization hypercalcemia should be considered as a differential diagnosis for such profile of patients.
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 Elbuken G, Yazicioglu B, Ozturk O, Demirag MD. A Rare Cause of Hypercalcemia: “Immobilization” A Case Report and Literature Review. Med-Science. Online First: 27 Jan, 2015