Which medications are used in the treatment of primary hyperparathyroidism?

Updated: Oct 02, 2018
  • Author: Lawrence Kim, MD, FACS, FACE; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Answer

Estrogen therapy in postmenopausal women has been shown to cause a small reduction in serum calcium (0.5-1 mg/dL) without a change in parathyroid hormone. Estrogen also has beneficial effects of lumbar spine and femoral neck bone mineral density (BMD). However, due to risks associated with estrogen replacement, it should not be used for the sole purpose of treating primary hyperparathyroidism.

Selective estrogen receptor modulators such as raloxifene have been shown to cause a decrease in serum calcium of the same magnitude observed with estrogen.

Bisphosphonates, in particular alendronate, has been shown to improve the BMD at the spine and hip BMD in patients with primary hyperparathyroidism. [20, 21] No significant change in parathyroid hormone, calcium, or 24-hour urinary calcium has been reported. Treatment with a bisphosphonate such as alendronate can be considered in patients with primary hyperparathyroidism and low BMD who cannot, or will not, undergo surgery.

Calcimimetic drugs activate the calcium-sensing receptor and inhibit parathyroid cell function. [22, 23] Treatment with cinacalcet resulted in reduction without normalization of parathyroid hormone levels, reduction and even normalization of serum calcium, but no increase in BMD was observed.


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