How are resorptive hypercalciuria and hyperparathyroidism treated?

Updated: Apr 23, 2019
  • Author: Stephen W Leslie, MD, FACS; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

The recommended treatment for patients with hyperparathyroidism who produce calcium stones is parathyroid surgery. For individuals who are unable or unwilling to undergo the surgery, medical treatment is available. Bisphosphonates are the medical agents of choice, because they correct the hypercalcemia, reduce bone resorption, and lower urinary calcium excretion. Orthophosphates and calcitonin can be used for these patients as well.

Thiazides should not be used in patients with hyperparathyroidism, even when hypercalciuria is present, because of the risk of increasing the hypercalcemia. (The only exception would be a short course for testing purposes in carefully selected patients, inducing a mild, controlled increase in serum calcium while monitoring the PTH level to see if it drops appropriately or is autonomous.)

Estrogens should be used in postmenopausal women with hypercalciuria whenever possible. Their action is similar to that of the bisphosphonates.

PTH actually stimulates osteoblastic and osteoclastic cells. High, sustained levels of PTH result in a net loss of calcium and bone mass, but research indicates that intermittent injections of PTH in animals and humans produce a net increase in osteoblastic activity and bone mass. This intermittent therapy, which appears promising as a potential treatment for osteoporosis, does not seem to significantly affect hypercalciuria or serum calcium levels.


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