Hypocalcemia in the older adult: Pathophysiology, diagnosis, and treatment

Hypocalcemia is a metabolic abnormality that is fairly commonly observed in older adults, as laboratory testing is often done to evaluate a variety of medical problems in these patients and the tests are often bundled without specifc reasons for obtaining them. This is frequently the case with serum calcium measurements, which are often included in a metabolic profle. Although most abnormalities found in the measurement of total serum calcium are due to either low or high levels of binding protein, failure to correct for this problem may lead to a missed diagnosis. When a more accurate measurement of serum calcium is needed, an ionized calcium level may be obtained. This test's readings are not affected by binding proteins; thus, it serves as a more accurate way to determine whether a patient's total serum calcium levels are normal, high, or low. When total serum calcium levels are found to be out of the normal range, many factors capable of infuencing the level of serum calcium must be considered, including levels of parathyroid hormone, vitamin D, magnesium, phosphorous, and calcium ions. This article reviews the pertinent clinical information on the incidence of hypocalcemia in the older adult and discusses underlying pathophysiological mechanisms and treatment options.