Hypophosphataemia following ferric carboxymaltose and ferric derisomaltose: case closed, but questions remain

Abstract

We read with interest the paper by Zoller et al comparing the rate of hypophosphataemia with ferric carboxymaltose (FCM) versus ferric derisomaltose (FDI) infusions in patients with inflammatory bowel disease (IBD).1 The higher rate of hypophosphataemia following FCM replicates findings of other studies in patients with and without IBD.2 3 Iron deficiency anaemia is associated with reduced quality of life, increased hospitalisation and impairments in physical and cognitive function in patients with IBD,4 and further evidence to support decision making regarding appropriate intravenous iron replacement is welcome.

The effect of FCM on markers of bone turnover, noted by Zoller and colleagues, is of particular concern, especially the persistence of raised bone-specific alkaline phosphatase (ALP) to day 70. Patients with IBD have a higher risk of osteopenia and osteoporosis due to chronic inflammation, steroid use and nutritional deficiencies.5 Given that the …