, Volume 66, Issue 17, pp 2189–2211 | Cite as

Current Pharmacological Options for the Management of Primary Hyperparathyroidism

  • Peter Vestergaard
Review Article


Drugs for treating primary hyperparathyroidism can be divided into two main groups: (i) antiresorptive drugs that inhibit the increased bone turnover, which can be divided into estrogen-like compounds (estrogen, oral contraceptives and selective estrogen receptor modulators [SERMs]), bisphosphonates and calcitonin; and (ii) drugs that interfere with parathyroid hormone (PTH) secretion (currently only cinacalcet is available). No drugs that interfere with PTH action are currently available.

Available studies suggest that all classes of drugs are able to lower serum calcium levels. However, calcitonin does so only temporarily. Estrogen-containing compounds (hormone replacement therapy) may be less attractive because of the potential risk of breast cancer, cardiovascular disease and deep vein thromboembolism. Oral contraceptives have not been shown to be able to prevent fractures in the general population, and no data are available on their effect in women with primary hyperparathyroidism. The only SERM marketed for hyperparathyroidism is raloxifene and this has not been associated with an increased risk of breast cancer and cardiovascular diseases, and has been shown to be able to prevent vertebral fractures in postmenopausal women with osteoporosis. Two small trials suggest that raloxifene may increase bone mineral density (BMD) and decrease serum calcium levels in patients with primary hyperparathyroidism. Bisphosphonates have been shown to decrease serum calcium and increase BMD in patients with primary hyperparathyroidism, but PTH levels may increase.

Cinacalcet effectively induces a sustained decrease in serum calcium and PTH for up to 1 year. However, BMD does not seem to increase.

No data on hard endpoints such as fractures, kidney stones, cardiovascular disease etc. are available for any of the drugs available for the treatment of primary hyperparathyroidism.


Bone Mineral Density Vertebral Fracture Alendronate Raloxifene Primary Hyperparathyroidism 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The author would like to thank research librarian Ms Edith Clausen for her skillful assistance with the references. No sources of funding were used to assist in the preparation of this review. The author has declared that he has no conflicts of interest that are directly relevant to the content of this review.


  1. 1.
    Jüppner H, Kronenberg HM. Parathyroid hormone. In: Favus MJ, editor. Primer on the metabolic bone diseases and disorders of mineral metabolism. Washington, DC: American Society for Bone and Mineral Research, 2003: 117–25Google Scholar
  2. 2.
    Joy MS, Kshirsagar AV, Franceschini N. Calcimimetics and the treatment of primary and secondary hyperparathyroidism. Ann Pharmacother 2004; 38: 1871–80PubMedCrossRefGoogle Scholar
  3. 3.
    Eriksen EF, Mosekilde L, Meisen F. Trabecular bone remodeling and balance in primary hyperparathyroidism. Bone 1986; 7: 213–21PubMedCrossRefGoogle Scholar
  4. 4.
    Charles P, Mosekilde L, Jensen FT. Primary hyperparathyroidism: evaluated by 47calcium kinetics, calcium balance and serum bone-Gla-protein. Eur J Clin Invest 1986; 16: 277–83PubMedCrossRefGoogle Scholar
  5. 5.
    Rao DS, Wilson RJ, Kleerekoper M, et al. Lack of biomechanical progression or continuation of accelerated bone loss in mild asymptomatic primary hyperparathyroidism: evidence for biphasic disease course. J Clin Endocrinol Metab 1988; 67: 1294–8PubMedCrossRefGoogle Scholar
  6. 6.
    Silverberg SJ, Gartenberg F, Jacobs TP, et al. Increased bone mineral density after parathyroidectomy in primary hyperparathyroidism. J Clin Endocrinol Metab 1995; 80: 729–34PubMedCrossRefGoogle Scholar
  7. 7.
    Wilson RJ, Rao S, Ellis B, et al. Mild asymptomatic primary hyperparathyroidism is not a risk factor for vertebral fractures. Ann Intern Med 1988; 109: 959–62PubMedGoogle Scholar
  8. 8.
    Moosgaard B, Vestergaard P, Heickendorff L, et al. Vitamin D status, seasonal variations, parathyroid adenoma weight and bone mineral density in primary hyperparathyroidism. Clin Endocrinol (Oxf) 2005; 63: 506–13CrossRefGoogle Scholar
  9. 9.
    Mundy GR, Cove DH, Fisken R. Primary hyperparathyroidism: changes in the pattern of clinical presentation. Lancet 1980; I: 1317-20CrossRefGoogle Scholar
  10. 10.
    Bilezikian JP, Potts JT Jr, Fuleihan G, et al. Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21st century. J Clin Endocrinol Metab 2002; 87: 5353–61PubMedCrossRefGoogle Scholar
  11. 11.
    Mollerup CL, Vestergaard P, Frøkjær VG, et al. Risk of renal stone events in primary hyperparathyroidism before and after parathyroid surgery: controlled retrospective follow up study. BMJ 2002; 325: 807–12PubMedCrossRefGoogle Scholar
  12. 12.
    Smith JC, Page MD, John R, et al. Augmentation of central arterial pressure in mild primary hyperparathyroidism. J Clin Endocrinol Metab 2000; 85: 3515–9PubMedCrossRefGoogle Scholar
  13. 13.
    Sancho JJ, Roucho J, Riera-Vidal R, et al. Long-term effects of parathyroidectomy for primary hyperparathyroidism on arterial hypertension. World J Surg 1992; 16: 732–6PubMedCrossRefGoogle Scholar
  14. 14.
    Paloyan D, Simonowitz D, Paloyan E, et al. Pancreatitis associated with primary hyperparathyroidism. Am Surg 1982; 48: 366–8PubMedGoogle Scholar
  15. 15.
    Procopio M, Magro G, Cesario F, et al. The oral glucose tolerance test reveals a high frequency of both impaired glucose tolerance and undiagnosed type 2 diabetes mellitus in primary hyperparathyroidism. Diabet Med 2002; 19: 958–61PubMedCrossRefGoogle Scholar
  16. 16.
    Vestergaard P, Mollerup CL, Frøkjær VG, et al. Cohort study of risk of fracture before and after surgery for primary hyperparathyroidism. BMJ 2000; 321: 598–602PubMedCrossRefGoogle Scholar
  17. 17.
    Hedback G, Oden A. Increased risk of death from primary hyperparathyroidism: an update. Eur J Clin Invest 1998; 28: 271–6PubMedCrossRefGoogle Scholar
  18. 18.
    Hedbäck G, Oden A, Tisell LE. The influence of surgery on the risk of death in patients with primary hyperparathyroidism. World J Surg 1991; 15: 399–405PubMedCrossRefGoogle Scholar
  19. 19.
    Vestergaard P, Mosekilde L. Cohort study on the effects of parathyroid surgery on multiple outcomes in primary hyperparathyroidism. BMJ 2003; 327: 530–5PubMedCrossRefGoogle Scholar
  20. 20.
    Eigelberger MS, Cheah WK, Ituarte PH, et al. The NIH criteria for parathyroidectomy in asymptomatic primary hyperparathyroidism: are they too limited? Ann Surg 2004; 239: 528–35PubMedCrossRefGoogle Scholar
  21. 21.
    Vestergaard P. Anti-resorptive therapy for the prevention of postmenopausal osteoporosis: when should treatment begin? Treat Endocrinol 2005; 4: 263–77PubMedCrossRefGoogle Scholar
  22. 22.
    Gallagher JC, Nordin BEC. Effects of oestrogen and progestogen therapy on calcium metabolism in post-menopausal women. Front Horm Res 1975; 3: 150–76PubMedGoogle Scholar
  23. 23.
    Gallagher JC, Nordin BEC. Treatment with oestrogens of primary hyperparathyroidism in post-menopausal women. Lancet 1972; I: 503–7CrossRefGoogle Scholar
  24. 24.
    Gallagher JC, Wilkinson R. The effect of ethinyloestradiol on calcium and phosphorus metabolism of postmenopausal women with primary hyperparathyroidism. Clin Sci Mol Med 1973; 45: 785–802PubMedGoogle Scholar
  25. 25.
    Selby PL, Peacock M. Ethinyl estradiol and norethindrone in the treatment of primary hyperparathyroidism in postmenopausal women. N Engl J Med 1986; 314: 1481–5PubMedCrossRefGoogle Scholar
  26. 26.
    Marcus R, Madvig P, Crim M, et al. Conjugated estrogens in the treatment of postmenopausal women with hyperparathyroidism. Ann Intern Med 1984; 100: 633–40PubMedGoogle Scholar
  27. 27.
    Haldimann B, Trechsel U, Dambacher MA, et al. Hyperparathy-roidie primaire de la femme agee: effect des oestrogenes sur le metabolism calcique [summary in English]. Schweiz Med Wochenschrift 1982; 112: 1242–5Google Scholar
  28. 28.
    Grey AB, Stapleton JP, Evans MC, et al. Effect of hormone replacement therapy on bone mineral density in postmenopausal women with mild primary hyperparathyroidism: a randomised controlled trial. Ann Intern Med 1996; 125: 360–8PubMedGoogle Scholar
  29. 29.
    Diamond T, Ng AT, Levy S, et al. Estrogen replacement may be an alternative to parathyroid surgery for the treatment of osteoporosis in elderly postmenopausal women presenting with primary hyperparathyroidism: a preliminary report. Oste-oporos Int 1996; 6: 329–33CrossRefGoogle Scholar
  30. 30.
    Herbai G, Ljunghall S. Treatment of primary hyperparathyroidism with cyclofenil: a synthetic stilbestrol derivative with minimal feminizing effects. Horm Metab Res 1984; 16: 374–6PubMedCrossRefGoogle Scholar
  31. 31.
    Herbai G, Ljunghall S. Normalization of hypercalcaemia in primary hyperparathyroidism by treatment with methallenes-tril, a synthetic oestrogen with low oestrogeneicity. Urol Int 1983; 38: 371–3PubMedCrossRefGoogle Scholar
  32. 32.
    Kuohung W, Borgatta L, Stubblefield P. Low-dose oral contraceptives and bone mineral density: an evidence-based analysis. Contraception 2000; 61: 77–82PubMedCrossRefGoogle Scholar
  33. 33.
    Vestergaard P, Rejnmark L, Mosekilde L. Oral contraceptive use and risk of fractures. Contraception 2006; 73: 571–6PubMedCrossRefGoogle Scholar
  34. 34.
    Cooper C, Hannaford P, Croft P, et al. Oral contraceptive pill use and fractures in women: a prospective study. Bone 1993; 14: 41–5PubMedCrossRefGoogle Scholar
  35. 35.
    Michaelsson K, Baron JA, Farahmand BY, et al. Oral-contraceptive use and risk of hip fracture: a case-control study. Lancet 1999; 353: 1481–4PubMedCrossRefGoogle Scholar
  36. 36.
    Vessey M, Mant J, Painter R. Oral contraception and other factors in relation to hospital referral for fracture: findings in a large cohort study. Contraception 1998; 57: 231–5PubMedCrossRefGoogle Scholar
  37. 37.
    Goldfien A. The gonadal hormones & inhibitors. In: Katzung BG, editor. Basic and clinical pharmacology. East Norwalk (CT): Appleton & Lange, 1987: 461–83Google Scholar
  38. 38.
    McDermott MT, Perloff JJ, Kidd GS. Effects of mild asymptomatic primary hyperparathyroidism on bone mass in women with and without estrogen replacement therapy. J Bone Mineral Res 1994; 9: 509–14CrossRefGoogle Scholar
  39. 39.
    Risks and benefits of estrogen plus progestin in healthy postme-nopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002; 288: 321–33Google Scholar
  40. 40.
    Cauley JA, Robbins J, Chen Z, et al. Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women’s Health Initiative randomized trial. JAMA 2003; 290: 1729–38PubMedCrossRefGoogle Scholar
  41. 41.
    The Women’s Health Initiative Steering Committee. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial. JAMA 2004; 291: 1701–12CrossRefGoogle Scholar
  42. 42.
    Torgerson DJ, Bell-Syer SEM. Hormone replacement therapy and prevention of nonvertebral fractures: a meta-analysis of randomized trials. JAMA 2001; 285: 2891–7PubMedCrossRefGoogle Scholar
  43. 43.
    Torgerson DJ, Bell-Syer SEM. Hormone replacement therapy and prevention of vertebral fractures: a meta-analysis of randomised trials. BMC Musculoskelet Disord 2001; 2: 7–10PubMedCrossRefGoogle Scholar
  44. 44.
    Vestergaard P, Rejnmark L, Mosekilde L. Fracture reducing potential of hormone replacement therapy on a population level. Maturitas 2006; 54: 285–93PubMedCrossRefGoogle Scholar
  45. 45.
    Beral V, Banks E, Reeves G. Evidence from randomised trials on the long-term effects of hormone replacement therapy. Lancet 2002; 360: 942–4PubMedCrossRefGoogle Scholar
  46. 46.
    Grady D, Rubin SM, Petitti DB, et al. Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med 1992; 117: 1016–37PubMedGoogle Scholar
  47. 47.
    Horowitz M, Wishart J, Need AG, et al. Treatment of postmenopausal hyperparathyroidism with norethindrone. Arch Intern Med 1987; 147: 681–5PubMedCrossRefGoogle Scholar
  48. 48.
    Zanchetta JR, Bogado CE. Raloxifene reverses bone loss in postmenopausal women with mild asymptomatic primary hyperparathyroidism. J Bone Miner Res 2001; 16: 189–90PubMedCrossRefGoogle Scholar
  49. 49.
    Rubin MR, Lee KH, McMahon DJ, et al. Raloxifene lowers serum calcium and markers of bone turnover in postmenopausal women with primary hyperparathyroidism. J Clin Endocrinol Metab 2003; 88: 1174–8PubMedCrossRefGoogle Scholar
  50. 50.
    Stone MD, Marshall DH, Hosking DJ, et al. Comparison of low-dose intramuscular and intravenous salcatonin in the treatment of primary hyperparathyroidism. Bone 1992; 13: 265–71PubMedCrossRefGoogle Scholar
  51. 51.
    Delmas PD, Ensrud KE, Adachi JD, et al. Efficacy of raloxifene on vertebral fracture risk reduction in postmenopausal women with osteoporosis: four-year results from a randomized clinical trial. J Clin Endocrinol Metab 2002; 87: 3609–17PubMedCrossRefGoogle Scholar
  52. 52.
    Ettinger B, Black DM, Mitlak BH, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. JAMA 1999; 282: 637–45PubMedCrossRefGoogle Scholar
  53. 53.
    Martino S, Cauley JA, Barrett-Connor E, et al. Continuing outcomes relevant to Evista: breast cancer incidence in postmenopausal osteoporotic women in a randomized trial of raloxifene. J Natl Cancer Inst 2004; 96: 1751–61PubMedCrossRefGoogle Scholar
  54. 54.
    Barrett-Connor E, Grady D, Sashegyi A, et al. Raloxifene and cardiovascular events in osteoporotic postmenopausal women: four-year results from the MORE (Multiple Outcomes of Raloxifene Evaluation) randomized trial. JAMA 2002; 287: 847–57PubMedCrossRefGoogle Scholar
  55. 55.
    Torring O, Bucht E, Sjostedt U, et al. Salmon calcitonin treatment by nasal spray in primary hyperparathyroidism. Bone 1991; 12: 311–6PubMedCrossRefGoogle Scholar
  56. 56.
    Cranney A, Tugwell P, Zytaruk N, et al. Meta-analysis of calcitonin for the treatment of postmenopausal osteoporosis. Endocr Rev 2002; 23: 540–51PubMedCrossRefGoogle Scholar
  57. 57.
    Chesnut CH III, Silverman S, Andriano KA, et al. A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the prevent recurrence of osteoporotic fractures study. PROOF Study Group. Am J Med 2000; 109: 267–76Google Scholar
  58. 58.
    Rossini M, Gatti D, Isaia G, et al. Effects of oral alendronate in elderly patients with osteoporosis and mild primary hyperparathyroidism. J Bone Mineral Res 2001; 16: 113–9CrossRefGoogle Scholar
  59. 59.
    Khan AA, Bilezikian JP, Kung AW, et al. Alendronate in primary hyperparathyroidism: a double-blind, randomized, placebo-controlled trial. J Clin Endocrinol Metab 2004; 89: 3319–25PubMedCrossRefGoogle Scholar
  60. 60.
    Chow CC, Chan WB, Li JK, et al. Oral alendronate increases bone mineral density in postmenopausal women with primary hyperparathyroidism. J Clin Endocrinol Metab 2003; 88: 581–7PubMedCrossRefGoogle Scholar
  61. 61.
    Parker CR, Blackwell PJ, Fairbairn KJ, et al. Alendronate in the treatment of primary hyperparathyroid-related osteoporosis: a 2-year study. J Clin Endocrinol Metab 2002; 87: 4482–9PubMedCrossRefGoogle Scholar
  62. 62.
    LoCascio V, Braga V, Bertoldo F, et al. Effect of bisphosphonate therapy and parathyroidectomy on the urinary excretion of galactosylhydroxylysine in primary hyperparathyroidism. Clin Endocrinol (Oxf) 1994; 41: 47–51CrossRefGoogle Scholar
  63. 63.
    Adami S, Zamberlan N, Mian M, et al. Duration of the effects of intravenous alendronate in postmenopausal women and in patients with primary hyperparathyroidism and Paget’s disease of bone. Bone Miner 1994; 25: 75–82PubMedCrossRefGoogle Scholar
  64. 64.
    Horiuchi T, Onouchi T, Inoue J, et al. A strategy for the management of elderly women with primary hyperparathyroidism: a comparison of etidronate therapy with parathy-roidectomy. Gerontology 2002; 48: 103–8PubMedCrossRefGoogle Scholar
  65. 65.
    Hamdy NA, Gray RE, McCloskey E, et al. Clodronate in the medical management of hyperparathyroidism. Bone 1987; 8: S69–77PubMedGoogle Scholar
  66. 66.
    Shane E, Baquiran DC, Bilezikian JP. Effects of dichloromethylene diphosphonate on serum and urinary calcium in primary hyperparathyroidism. Ann Intern Med 1981; 95: 23–7PubMedGoogle Scholar
  67. 67.
    Douglas DL, Kanis JA, Paterson AD, et al. Drug treatment of primary hyperparathyroidism: use of clodronate disodium. BMJ (Clin Res Ed) 1983; 286: 587–90CrossRefGoogle Scholar
  68. 68.
    Ammann P, Herter-Clavel C, Lubrano A, et al. A single bisphosphonate infusion is associated with improved functional capacity in elderly subjects with primary hyperparathyroidism. Aging Clin Exp Res 2003; 15: 500–4PubMedGoogle Scholar
  69. 69.
    Reasner CA, Stone MD, Hosking DJ, et al. Acute changes in calcium homeostasis during treatment of primary hyperparathyroidism with risedronate. J Clin Endocrinol Metab 1993; 77: 1067–71PubMedCrossRefGoogle Scholar
  70. 70.
    Cranney A, Wells G, Willan A, et al. Meta-analysis of alendronate for the treatment of postmenopausal women. Endocr Rev 2002; 23: 508–16PubMedCrossRefGoogle Scholar
  71. 71.
    Black DM, Cummings SR, Kerpf DB, et al. Randomised trial of the effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 1996; 348: 1535–41PubMedCrossRefGoogle Scholar
  72. 72.
    Douglas DL, Duckworth T, Russell RG, et al. Effect of dichloromethylene diphosphonate in Paget’s disease of bone and in hypercalcaemia due to primary hyperparathyroidism or malignant disease. Lancet 1980; 1: 1043–7PubMedCrossRefGoogle Scholar
  73. 73.
    Hoffmeyer P, Groebli Y, Spiliopoulos A, et al. Clodronate therapy of hypercalcemia caused by hyperparathyroidism [in German]. Schweiz Med Wochenschr 1982; 112: 118–20PubMedGoogle Scholar
  74. 74.
    McCloskey E, Selby P, Davies M, et al. Clodronate reduces vertebral fracture risk in women with postmenopausal or secondary osteoporosis: results of a double-blind, placebo-controlled 3-year study. J Bone Miner Res 2004; 19: 728–36PubMedCrossRefGoogle Scholar
  75. 75.
    Licata AA, O’Hanlon E. Treatment of hyperparathyroidism with etidronate sodium. JAMA 1983; 249: 2063–4PubMedCrossRefGoogle Scholar
  76. 76.
    Kaplan RA, Geho WB, Poindexter C, et al. Metabolic effects of diphosphonate in primary hyperparathyroidism. J Clin Pharmacol 1977; 37: 410–9Google Scholar
  77. 77.
    Cranney A, Guyatt G, Krolicki N, et al. A meta-analysis of etidronate for the treatment of postmenopausal osteoporosis. Osteoporosis Int 2001; 12: 140–51CrossRefGoogle Scholar
  78. 78.
    Cranney A, Tugwell P, Adachi J, et al. Meta-analysis of risedronate for the treatment of postmenopausal osteoporosis. Endocr Rev 2002; 23: 517–23PubMedCrossRefGoogle Scholar
  79. 79.
    Häuselmann HJ, Rizzoli R. A comprehensive review of treatments for postmenopausal osteoporosis. Osteoporosis Int 2003; 14: 2–12CrossRefGoogle Scholar
  80. 80.
    Brumsen C, Papapoulos SE, Lips P, et al. Daily oral pamidronate in women and men with osteoporosis: a 3-year randomized placebo-controlled clinical trial with a 2-year open extension. J Bone Miner Res 2002; 17: 1057–64PubMedCrossRefGoogle Scholar
  81. 81.
    Reid IR, Wattie DJ, Evans MC, et al. Continuous therapy with pamidronate, a potent bisphosphonate, in postmenopausal osteoporosis. J Clin Endocrinol Metab 1994; 79: 1595–9PubMedCrossRefGoogle Scholar
  82. 82.
    de Groen PC, Lubbe DF, Hirsch LJ, et al. Esophagitis associated with the use of alendronate. N Engl J Med 1996; 335: 1016–21PubMedCrossRefGoogle Scholar
  83. 83.
    Quarles LD. Extracellular calcium-sensing receptors in the parathyroid gland, kidney, and other tissues. Curr Opin Nephrol Hypertens 2003; 12: 349–55PubMedCrossRefGoogle Scholar
  84. 84.
    Peacock M, Bilezikian JP, Klassen PS, et al. Cinacalcet hydrochloride maintains long-term normocalcemia in patients with primary hyperparathyroidism. J Clin Endocrinol Metab 2005; 90: 135–41PubMedCrossRefGoogle Scholar
  85. 85.
    Shoback DM, Bilezikian JP, Turner SA, et al. The calcimimetic cinacalcet normalizes serum calcium in subjects with primary hyperparathyroidism. J Clin Endocrinol Metab 2003; 88: 5644–9PubMedCrossRefGoogle Scholar
  86. 86.
    Block GA, Martin KJ, de Francisco AL, et al. Cinacalcet for secondary hyperparathyroidism in patients receiving hemodi-alysis. N Engl J Med 2004; 350: 1516–25PubMedCrossRefGoogle Scholar
  87. 87.
    Lindberg JS, Moe SM, Goodman WG, et al. The calcimimetic AMG 073 reduces parathyroid hormone and calcium x phosphorus in secondary hyperparathyroidism. Kidney Int 2003; 63: 248–54PubMedCrossRefGoogle Scholar
  88. 88.
    Quarles LD, Sherrard DJ, Adler S, et al. The calcimimetic AMG 073 as a potential treatment for secondary hyperparathyroidism of end-stage renal disease. J Am Soc Nephrol 2003; 14: 575–83PubMedCrossRefGoogle Scholar
  89. 89.
    Rubin M, Sliney J, McCary LC, et al. Effective management of severe hypercalcemia with the calcimimetic cinacalcet HCI in patients with parathyroid carcinoma. J Bone Miner Res 2003; 18 Suppl. 2: S392Google Scholar
  90. 90.
    Rubin MR, Sliney J, Silverberg SJ, et al. Clinical course of 10 patients with inoperable parathyroid carcinoma treated with the calcimimetic cinacalcet HCl. J Bone Miner Res 2004; 19 Suppl. 1: S103Google Scholar
  91. 91.
    Silverberg SJ, Faiman C, Bilezikian JP, et al. Cinacalcet HCl effectively treats hypercalcemia in patients with parathyroid carcinoma. J Bone Miner Res 2004; 19 Suppl. 1: S103Google Scholar
  92. 92.
    Goodman WG, Hladik GA, Turner SA, et al. The calcimimetic agent AMG 073 lowers plasma parathyroid hormone levels in hemodialysis patients with secondary hyperparathyroidism. J Am Soc Nephrol 2002; 13: 1017–24PubMedGoogle Scholar
  93. 93.
    Hasling C, Charles P, Mosekilde L. Etidronate disodium for treating hypercalcaemia of malignancy: a double blind, placebo-controlled study. Euro J Clin Invest 1986; 16: 433–7CrossRefGoogle Scholar
  94. 94.
    Pecherstorfer M, Brenner K, Zojer N. Current management strategies for hypercalcemia. Treat Endocrinol 2003; 2: 273–92PubMedCrossRefGoogle Scholar
  95. 95.
    Wisneski LA, Croom WP, Silva OL, et al. Salmon calcitonin in hypercalcemia. Clin Pharmacol Ther 1978; 24: 219–22PubMedGoogle Scholar
  96. 96.
    Ralston SH, Gallacher SJ, Patel U, et al. Comparison of three intravenous bisphosphonates in cancer-associated hypercalcaemia. Lancet 1989; 2: 1180–2PubMedCrossRefGoogle Scholar
  97. 97.
    Adami S, Zamberlan N. Adverse effects of bisphosphonates: a comparative review. Drug Saf 1996; 14: 158–70PubMedCrossRefGoogle Scholar
  98. 98.
    Kantorovich V, Gacad MA, Seeger LL, et al. Bone mineral density increases with vitamin D repletion in patients with coexistent vitamin D insufficiency and primary hyperparathy-roidism. J Clin Endocrinol Metab 2000; 85: 3541–3PubMedCrossRefGoogle Scholar
  99. 99.
    Lind L, Wengle B, Sorensen OH, et al. Treatment with active vitamin D (alphacalcidol) in patients with mild primary hyperparathyroidism. Acta Endocrinol (Copenh) 1989; 120: 250–6Google Scholar
  100. 100.
    Broadus AE, Magee JS, Mallette LE, et al. A detailed evaluation of oral phosphate therapy in selected patients with primary hyperparathyroidism. J Clin Endocrinol Metab 1983; 56: 953–61PubMedCrossRefGoogle Scholar
  101. 101.
    Ljunghall S, Rudberg C, Åkerström G, et al. Effects of beta-adrenergic blockade on serum parathyroid hormone in normal subjects and patients with primary hyperparathyroidism. Acta Med Scand 1982; 211: 27–30PubMedCrossRefGoogle Scholar
  102. 102.
    Fisken RA, Wilkinson R, Heath DA. The effects of cimetidine on serum calcium and parathyroid hormone levels in primary hyperparathyroidism. Br J Clin Pharmacol 1982; 14: 701–5PubMedCrossRefGoogle Scholar
  103. 103.
    Wiske PS, Epstein S, Norton JA Jr, et al. The effects of intravenous and oral cimetidine in primary hyperparathyroidism. Horm Metab Res 1983; 15: 245–8PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2006

Authors and Affiliations

  • Peter Vestergaard
    • 1
  1. 1.The Osteoporosis Clinic, Aarhus AmtssygehusAarhus University HospitalAarhus CDenmark

Personalised recommendations