This handout is for hyperparathyroidism (primary, secondary, tertiary). Your care team identified this based on: incidental hypercalcemia on routine labs (4th international workshop bilezikian jcem 2014).
Other reasons your team may use this plan: recurrent calcium-containing kidney stones (4th international workshop 2014 surgical criterion); fragility fracture or osteoporosis (4th international workshop 2014 t-score criterion); elevated pth in ckd — secondary hpt (kdigo 2017 ckd-mbd).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| cinacalcet | 30 mg, titrate to 90 mg q6h | PO | daily, titrate to BID/TID | Reduces calcium; FDA-approved for non-surgical pHPT (AACE/ACE 2022; 4th International Workshop 2014 medical management) |
| alendronate | 70 mg weekly | PO | weekly | Improves BMD; does not lower Ca substantially (Khan JCEM 2017; AACE/ACE 2022) |
| zoledronic_acid | 4 mg IV (5 mg for osteoporosis) | IV | q3–4 wks for hypercalcemia of malignancy; q1y for OP | Aggressive Ca lowering; ONJ risk (AACE/ACE 2022; NICE 2019) |
| denosumab | 60 mg q6m for OP; 120 mg q4w for hypercalcemia of malignancy | SC | q6m or q4w | Alternative to bisphosphonate; no renal limit; ONJ risk (AACE/ACE 2022) |
| cholecalciferol | 1000–2000 IU daily | PO | daily | Repletion before surgery to optimise outcomes (Bilezikian JCEM 2014; AACE/ACE 2022) |
Plan: Medical management of primary HPT
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Endo / surgery follow-up; family screen if MEN; bone health long-term (AACE/ACE 2022; 4th International Workshop 2014)
Guideline: SBM 2014 4th International Workshop Asymptomatic pHPT (Bilezikian); AAES 2016 surgical guideline; KDIGO 2017 CKD-MBD