[Pathophysiology of hypercalcemia and the therapeutic role of bisphosphonates]

When hypercalcemia is found in patients with malignancy, it is necessary to measure circulating parathyroid hormone -related peptide concentrations and to search for bone lesions. Because accelerated bone resorption mainly contributes to malignancy associated hypercalcemia, bisphosphonates, which strongly suppress osteoclastic resorption, is most effective. Upon administration of bisphosphonates, serum calcium begins to fall within two days, reaches the bottom after one week, and the effects disappear after two or three weeks. In case of need to lower the serum calcium concentration rapidly, calcitonin should be used at the same time.